Download diagnostic radiology resident manual

DIAGNOSTIC
RADIOLOGY
RESIDENT
MANUAL
Revised August 27th, 2013
TABLE OF CONTENTS
How to Use This Manual........………………………………………………….……………………..………………1
Section 1: Program Information
Definition………………………………………………………………………………….……………...……………...3
Goals …………………………………………………………………………………………………...………………..3
Specific Objectives
Medical Expert/Clinical Decision Maker…………………………………………………………………….3
Communicator…………………………………………………………………………………………………4
Collaborator…………………………………………………………………………………………………....5
Manager………………………………………………………………………………………………………..5
Health Advocate……………………………………………………………………………………………….6
Scholar………………………………………………………………………………….………………………6
Professional…………………………………………………………………………………………………….7
Training in Canada……………………………………………………………………………………….……………. 8
Organizational Outline of the Program………………………………………………………………....………….... 8
Residency Training Committee………………………………………………………………………………………..8
General Terms of Reference for Residency Training Committees………………………………………………..9
Overview of Rounds and Teaching………………………………………………………………………………….10
Responsibilities of Residents………………………………………………………………………………………...11
Journal Club……………………………………………………………………………………………………………12
Critical Appraisal Course……………………………………………………………………………………………..12
Physics Course………………………………………………………………………………………….………….…12
Departmental Management Course………………………………………………………………….……………..12
Visiting Professor Program…………………………………………………………………………………………..12
Ethics Training…………………………………………………………………………………………………………12
Communications Training…………………………………………………………………………………………….13
Fundamentals of Radiology Series………………………………………………………………………………….13
Etiquette………………………………………………………………………………………………………………..13
Resident Call Duties…………………………………………………………………………………………………..13
On Call Reporting Policy…………………………………………………………………………………………… 14
Post Call Policy………………………………………………………………………………………………………..14
Diagnostic Radiology Reports……………………………………………………………………………………….15
A. The Diagnostic Radiology Report………………………………………………………………………15
B. Written Communication………………………………………………………………………………….17
C. Direct Communication…………………………………………………………………………………...17
Supervision of Residents……………………………………………………………………………………………..18
Attending Radiologist Responsibilities…………………………………………………………………...…………18
Resident Responsibilities…………………………………………………………………………………………….19
Program Outline…………………………………………………………………………………………………….…20
By Number of Months per Year………………………………………………………………………….…20
By Number of Months per Rotation……………………………………………………………………..…21
PGY1 Rotations……………………………………………………………………………………………...22
Aims and Objectives for the PGY1 Program…………………………………………………....23
Resident Evaluations………………………………………………………………………………………………….24
Background…………………………………………………………………………………………………..24
Process of Evaluation……………………………………………………………………………………….24
What is WebEvaluation……………………………………………………………………………………..24
Core Benefits of WebEval………………………………………………………………………………….24
Benefits for Electronic Evaluation…………………………………………………………….……………24
How does it work?.................................................................................................................................24
Guide to Resident Evaluation…………………………………………………………………………....…………..25
Evaluation Tools………………………………………………………………………………..…..………..25
Contingencies for Failure to Meet Defined Minimum Performance Standards………………….…..….………26
1. Ethics Conduct………………………………………………………………………….……..…….……26
2. Research………………………………………………………………………………….…….…..……..26
3. Levels PGY2, PGY3, PGY4…………………………………………………………….…………...…..27
Evaluation Process………………………………………………………………………………….…………...…....29
Conflict Resolution and Appeals……………………………………………………………………….…………….31
Appeal Procedure for an Unsatisfactory Evaluation……………………………………………………………….32
Pathway for Appeals………………………………………………………………………………………………….32
The Residency Appeal Process………………………………………………………………………….……….…32
Resident Research………………………………………………………………………………………..…………..34
Qualifying project types…………………………………………………………………………..………....34
Less Desirable Project Types…………………………………………………………………..…………..34
Definition of completion…………………………………………………………………………..………....34
Time…………………………………………………………………………………………………..…....….34
Mentors………………………………………………………………………………………………...….….35
Key Research Contacts within Department of Medical Imaging…………………………………....…..35
Radiology Research Documentation……………………………………………………………….…...…35
Financial Support for Radiology Research……………………………………………………….….…....36
Human Investigation Committee ………………………………………………………………….….……36
Financial Impact Statement……………………………………………………………………..……..…...36
Completion of Project……………………………………………………………………………..…..…….37
Guidelines for Resident Research Projects…………………………………………………………………….…..38
A Three Phase Venture……………………………………………………………………………….…….38
1.
Proposal……………………………………………………………………………………………..38
2.
Study…………………………………………………………...……………………………………38
3.
Presentation ………………………………………………………………..………………………38
I.
Proposal ………………………………………………………………………………….…………38
II.
Study – Consideration for Designing a Research Project ……………………………………..39
III.
Paper ………………………………………………………………………………………….…….40
Completion of Project ………………………………………………………………………………………………....41
Guidelines for Manuscript………………………………….………………………………………………………….41
Resident Travel ……………………………………………….………………………………………………………42
Funding Guidelines …………………………………….……………………………………………….…..42
Important Points ……………………………………………………………………………………….……42
Other Relevant Departmental Policies ………………………………………………………………………….….43
Conference Leave ……………………………………………….……………………………………….…43
Sick Leave……………………………………………………………..……………………………………..43
Vacation Time…………………………………………………………….………………………………….43
Critical Incident and Stress Policy ………………………………………….……………………………..44
Purpose ………………………………………………………………….………………………....44
Scope ……………………………………………………………………….……………………...44
Definitions …………………………………………………………………………………….……44
Policy and Procedures………………………………………………………………………….…44
Reporting a Critical Incident…………………………………………….………………44
Reporting a Significant Stressor………………………………………………………..45
Referral and Meeting Guidelines…………………………………………………….....45
Harassment Policy ………………………………………………………………………………………….46
Memorial University Radiology Residency Program Safety Policy ……………………………………46
Dress Code as per Memorial University Faculty of Medicine…………………………………………..47
Program Transfer Policy……………………………………………………………………………………47
Eastern Health Policies……………………………………………………………………………………..48
Recommended Reading……………………………………………………………………………………………...51
A. General Text ……………………………………………………………………………………………..51
B. Chest………..……………………………………………………………………………………………..51
C. Cardiology…….…………………………………………………………………………………………..51
D. Mammography….………………………………………………………………………………………..54
E. Pediatrics……………...………………………………………………………………………………….54
F. Gastrointestinal…………………….…………………………………………………………………….54
G. Genitourinary……………………………………………………………………………………………..55
H. Skeletal……………………………………..……………………………………………………………..55
I. Neuroradiology………………………….…………………………………………..……………………..55
J. Ear, Nose and Throat….……………………………………………………………….…….…………..56
K. Angiography and Interventional…………………………………………………………….…………..56
L. CT and MRI……………………………………..……………………………………………….………..56
M. Ultrasound………………………………………………………………………………………………..56
N. Nuclear Medicine………………………………………………………….……………………………..57
O. Physics……………………………………………………………………………..……………………..57
P. Biostatistics………………………………………………………………………………………………..57
Q. Radiobiology………………………………………………………………………….…………………..57
Section 2: Aims and Objectives: PGY I RCPSC Specialty Programs………………………………………58
Introduction ………………………………………………………….……………………………………….59
Emergency Component of the PGY I Program………………...….……………………………………..60
Internal Medicine Component of the PGY I Program………………………………..…………………..63
Obstetrics & Gynecology Component of the PGY I Program…………….……………………………..68
Pediatric Component of the PGY I Program……………………………………………………………...73
Psychiatry Component of the PGY I Program……………………………………………………………76
Surgery Component of the PGY I Program…….….……………………………………………………..81
Section 3: Specific Rotation Objectives…………………………………………………………………………89
Angiography/Interventional Radiology (HSC/SCM…) ……………………………………………………………90
Body Imaging (HSC): PGY2…………………………………………………………………………………………94
Body Imaging (HSC): PGY3…………………………………………………………………………………………97
Body Imaging (HSC): PGY4………………………………………………………………………………………..100
Body Imaging (HSC): PGY5………………………………………………………………………………………..103
Body Imaging (SCM)………………………………………………………………………………………………..108
Pulmonary and Cardiovascular Radiology (HSC/SCM): PGY2 ………………………………………….…….112
Pulmonary and Cardiovascular Radiology (HSC/SCM): PGY3…………………..…………………………….115
Pulmonary and Cardiovascular Radiology (HSC/SCM): PGY4…………………….……………….………….118
Pulmonary and Cardiovascular Radiology (HSC/SCM): PGY5…………………….……….………………….121
Emergency Radiology: PGY2 ……………………………………………………………………………………...126
Gastrointestinal – Abdominal Imaging: PGY2 & PGY5………………………………………………………….133
Genitourinary Radiology: PGY2…………………………………………………………………………………....137
Mammography: PGY3, PGY4, & PGY5 …………………………………………………………………………..144
MRI: PGY3 & PGY5…………………………………………………………………………………………………149
Musculoskeletal Radiology (HSC): Level I………………………………………………………………………..156
Musculoskeletal Radiology (HSC): Level II……………………………………………………………...………..160
Musculoskeletal Radiology (HSC): Level III……………………………………………………………..………..166
Musculoskeletal Radiology (SCM): Level I………………………………………………………………………..173
Musculoskeletal Radiology (SCM): Level II…………………………………………………………..…………..180
Musculoskeletal Radiology (SCM): Level III…………………………………………….………………………..187
Neuroradiology: Level I (PGY2)……………………………………………………………………………………194
Neuroradiology: 2 months - Level II (PGY3)…………………………………………………………………......199
Neuroradiology: 1 month – Level III (PGY5)……………………………………………………………………...204
Nuclear Medicine: PGY3 & PGY5………………………………………………………………………………….208
Obstetrical Ultrasound: PGY4 & PGY5……………………………………………………………………………212
Pediatrics: Introductory Month……………………………………………………………………………………..215
Pediatrics: PGY4 & PGY5………………………………………………………………………………………….218
Rural Rotation: PGY4…………………………………………………………………………….…………………221
Ultrasound (HSC): Introductory Month……………………………………………………………………………224
Ultrasound (HSC): PGY3……………………………………………………………………………….…………..230
Ultrasound (HSC): Senior Rotations (PGY4 & 5)……………………………………………………….………..236
Ultrasound (SCM): Introductory Month……………………………………………………………………….……241
Ultrasound (SCM): PGY3……………………………………………………………………………..………….…246
Ultrasound (SCM): Senior Rotations (PGY4 & 5)……………………………………………….……………….252
Appendix One: Resident Safety Policy Procedure……………………………………………………………….257
Appendix Two: Aims and Objectives: PGY I RCPSC Specialty Programs……………………………………261
HOW TO USE THIS MANUAL
This manual is divided into 3 sections for ease of reference:
SECTION 1 – Contains program information regarding Royal College training requirements,
MUN Radiology General Program Goals and objectives, organization of the program, Terms of
Reference of the Residency Training Committee, evaluations and appeals processes, research
criteria, departmental and Eastern Health policies.
SECTION 2 - Contains goals and objectives for the PGY1 year of basic clinical training.
SECTION 3 - Contains rotation specific clinical radiology goals and objectives to be achieved
during rotations at various levels of training. These objectives form the basis of rotation evaluations.
All residents should familiarize themselves with the contents of SECTION 1. First year residents
should review Section 2. Residents should review appropriate parts in SECTION 3 before each
radiology rotation and referred to throughout the rotation.
COPYRIGHT NOTICE
Copyright ©2012 Memorial University of Newfoundland
CANMeds competencies throughout this manual have been adapted with permission
for our rotation objectives from the CANMeds Program of the Royal College of
Physicians and Surgeons on Canada.
http://www.royalcollege.ca/public/canmeds/whatworks
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SECTION 1
Program Information
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DEFINITION
Diagnostic Radiology is a branch of medical practice concerned with the use of imaging techniques
in the study, diagnosis and treatment of disease.
GOALS
On completion of the educational program, the graduate physician will be competent to function as
a consultant in Diagnostic Radiology. This requires the physician to have the ability to supervise,
advise on and perform imaging procedures to such a level of competence, and across a broad
range of medical practice, as to function as a consultant to referring family physicians and
specialists.
Communication skills, knowledge, and technical skills are the three pillars on which a radiological
career is built, and all are dependent on the acquisition of an attitude to the practice of medicine
which recognizes both the need to establish a habit of continuous learning and a recognition of the
importance of promoting a team approach to the provision of imaging services. Residents must
demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to
Diagnostic Radiology. In addition, all residents must demonstrate an ability to incorporate gender,
culture and ethnic perspectives in research methodology, data presentation and analysis.
SPECIFIC OBJECTIVES
At the completion of training, the resident will have acquired the following competencies
and will function effectively as a:
Medical expert/clinical decision-maker
General Requirements:
• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
•
Access and apply relevant information to clinical practice so as to have competence in
clinical radiological skills.
•
Demonstrate effective consultation services with respect to patient care, education and legal
opinions
Specific Requirements:
• Understand the nature of formation of all types of radiological images, including physical
and technical aspects, patient positioning, contrast media.
•
Knowledge of the theoretical, practical and legal aspects of radiation protection, including
other imaging techniques and their possible harmful effects.
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•
Knowledge of human anatomy at all ages, both conventional and multiplanar, with emphasis
on radiological applications.
•
Knowledge of all aspects of clinical radiology, including understanding of disease,
appropriate application of imaging to patients, importance of informed consent,
complications such as contrast media reactions, and factors affecting interpretation and
differential diagnosis.
•
Understand the fundamentals of quality assurance in radiology.
•
Understand the fundamentals of epidemiology, biostatistics and decision analysis.
•
Show competence in manual and procedural skills and in diagnostic and interpretive skills.
•
Demonstrate the ability to manage the patient independently during a procedure, in close
association with a specialist or other physician who has referred the patient. The radiologist
should know when the patients’ best interests are served by discontinuing a procedure, or
referring the patient to another physician.
•
Understand the acceptable and expected results of investigations and/or interventional
therapy as well as unacceptable and unexpected results. This must include knowledge of
and ability to manage radiological complications effectively.
•
Understand the appropriate follow-up care of patients who have received investigations
and/or interventional therapy.
•
Show understanding of a sound and systematic style of reporting.
•
Competence in effective consultation, conduct of clinico-radiological conferences, and the
ability to present scholarly material and lead case discussions.
•
These objectives are achieved frequently over the 5 year training.
objectives are listed in SECTION 3.
Individual rotation
Communicator
General Requirements:
• Establish appropriate therapeutic relationships with patients/families.
•
Listen effectively.
•
Obtain the appropriate information during consultation with referring physicians in order to
be able to make recommendations regarding the most appropriate testing and/or
management of patients.
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•
Discuss appropriate information with patients/families and the health care team, and be able
to obtain informed consent for tests and procedures when this is needed.
Specific Requirements:
• Have the ability to produce a radiologic report which will describe the imaging findings, most
likely differential diagnoses, and, when indicated, recommend further testing and/or
management.
•
Understand the importance of communication with referring physicians, including an
understanding of when the results of an investigation or procedure should be urgently
communicated.
•
Communicate effectively with patients and their families and have a compassionate interest
in them.
•
Recognize the physical and psychological needs of the patient and their families undergoing
radiological investigations and/or treatment, including the needs of culture, race and gender.
Collaborator
General Requirements:
• Consult effectively with other physicians and health care professionals.
•
Contribute effectively to other interdisciplinary team activities.
Specific Requirements:
• Have the ability to function as a member of a multi-disciplinary health care team in the
optimal practice of radiology.
•
The skills of being a collaborator are developed on a day to day basis. Residents are
strongly encouraged to interact with house staff and referring physicians as “first contact” in
order to better develop these skills. In addition, residents will be required to be active
participants in inter and intra discipline rounds.
Manager
General Requirements:
• Utilize resources effectively to balance patient care, learning needs, and other activities.
•
Allocate finite health care resources wisely.
•
Work effectively and efficiently in a health care organization.
•
Utilize information technology to optimize patient care, life-long learning and other activities.
5
Specific Requirements:
• Be competent in conducting or supervising quality assurance including an understanding of
safety issues and economic considerations.
•
Be competent in computer science as it pertains to the practice of radiology.
•
These skills are learned on a day to day basis as well as through lectures. These lectures
are given by the Department Manager and will teach residents how to run a department in
terms of issues of equipment and staffing. In addition, residents will be exposed to
situations when equipment is purchased for the department and through this will learn the
basics of equipment purchase and tendering. The role of chief resident is another
opportunity to develop managerial skills.
Health Advocate
General Requirements:
• Identify the important determinants of health affecting patients.
•
Contribute effectively to improve the health of patients and communities.
•
Recognize and respond to those issues where advocacy is appropriate.
Specific Requirements:
• Understand and communicate the benefits and risks of radiological investigation and
treatment including population screening.
•
Recognize when radiological investigation or treatment would be detrimental to the health of
a patient.
•
Educate and advise on the use and misuse of radiological imaging.
•
These skills are learned on a day to day basis and are incorporated as in the objectives of
medical experts/decision maker. In addition, community involvement of residents will be
encouraged including community education and charity projects.
Scholar
General Requirements:
• Develop, implement and monitor a personal continuing education strategy.
•
Critically appraise sources of medical information.
•
Facilitate learning of patients, house staff/students and other health professionals.
•
Contribute to development of new knowledge.
6
Specific Requirements:
• Competence in evaluation of the medical literature.
•
The ability to be an effective teacher of radiology to medical students, residents,
technologists and clinical colleagues.
•
The ability to conduct a radiology research project, which may include quality assurance.
•
Appreciation of the important role that basic and clinical research plays in the critical
analysis of current scientific developments related to radiology.
•
The skills of being a medical scholar are learned on a day to day basis under the umbrella of
a long term plan. For a resident, this would include seeing as many cases as possible
during the days with follow-up reading performed at night. It is recommended that a junior
resident be reading at least two hours a night whereas a senior resident should be planning
to read approximate four to six hours per night. It is very important not to fall behind and to
understand the personal commitment to radiology and the personal responsibility. Critical
appraisal skills will be enhanced through Journal Club but these skills should not, of course,
be limited to this. Residents also participate in the TIPS workshop. Residents will be
required to present and teach to other residents, medical students and house staff. In
addition residents will be introduced to the MCOMP format through rounds which are
accredited and therefore upon graduation will be able to maintain a recording of their
scholarly activities using the MCOMP format (which is necessary for fellowship of the Royal
College).
Professional
General Requirements:
• Deliver highest quality care with integrity, honesty and compassion.
•
Exhibit appropriate personal and interpersonal professional behaviours.
•
Practice medicine ethically consistent with the obligations of a physician respecting the
needs of culture, race and gender.
Specific Requirements:
• Be able to accurately assess one’s own performance, strengths and weaknesses.
•
Understand the ethical and medical-legal requirements of radiologists.
•
The skills of being a medical professional were first introduced in medical school and are
carried through the residency program and beyond. These qualities are developed through
day to day activities on a continuing basis and hopefully enhanced through role models.
•
Please see below the Physician Charter.
7
Training in Canada
The foregoing represents the general and specific objectives that all candidates for the Royal
College examinations in Diagnostic Radiology are expected to meet. For those training in Canadian
programs, these objectives will be accomplished in a staged manner. Residents in Canadian
programs may obtain the document describing this approach from their program directors.
Revised into CanMEDS format - May 2000 and August 2010
ORGANIZATIONAL OUTLINE OF THE PROGRAM
Professor and Chairperson
Program Director
Research Director
HSC Residency Coordinator
St. Clare’s Residency Coordinator
Janeway Residency Coordinator
Nuclear Medicine
Medical Physics Coordinator
Benvon Cramer, MD, FRCPC
Angus Hartery, MD, FRCPC, ABR
Ravi Gullipalli, MBBS, MRCS, FRCR
Scott Harris, MD, FRCPC
Cheryl Jefford, MD, FRCPC
Angela Pickles, MD, FRCPC
Peter Hollett, MD, FRCPC
Edward Kendall, Ph.D
RESIDENCY TRAINING COMMITTEE
Chairperson
HSC Residency Coordinator
St. Clare’s Residency Coordinators
Janeway Residency Coordinator
Physics Coordinator
Research Director
Nuclear Medicine Coordinator
Professor and Chair (Ex-officio)
Administrative Resident
Junior Resident
Program Administrator
Program Assistant
Recording Secretary
Dr. Angus Hartery
Dr. Scott Harris
Dr. Connie Hapgood
Dr. Cheryl Jefford
Dr. Angie Pickles
Dr. Edward Kendall
Dr. Ravi Gullipalli
Dr. Peter Hollett
Dr. Benvon Cramer
Dr. Suzanne Byrne
Dr. Chris Smith
Ms. Jennifer Collins
Ms. Margie Chafe
Ms. Jennifer Collins
The Diagnostic Radiology Residency Training Committee meets approximately every three months
throughout the academic year. All major decisions, complaints, and concerns should be voiced
and discussed at this meeting. The residents are strongly encouraged to present the residents’
concerns formally at this meeting. Individual residents should bring their concerns to the
Administrative Resident and/or to other residents that may be on the Committee. As well, initial
discussion should take place at each hospital site with the Residency Coordinator. The Program
8
Director is always available as well.
GENERAL TERMS OF REFERENCE FOR RESIDENCY TRAINING COMMITTEES
To develop a clear program plan, including objectives relating to knowledge, skills, and attitudes and based
upon the general objectives of training in the specialty as published in the specialty training requirements of
the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada,
which plan should also indicate the methods by which the objectives are to be achieved and the role played
by each rotation and by each participating institution;
To select candidates for admission to the program, in accordance with policies determined by the faculty
postgraduate medical education committee;
To conduct the program, including the rotation of residents to ensure that each resident is advancing and
gaining in experience and responsibility in accordance with the educational plan;
To establish mechanisms to provide career planning and counseling for residents and to deal with problems
such as those related to psychological stress;
To assess performance of each resident through a well organized program of in-training evaluation which
will include the final evaluation at the end of the program as required by the College;
To maintain an appeal mechanism through which the residency program committee should receive and
review appeals from residents and, where appropriate, refer the matter to the faculty Postgraduate Medical
Studies Committee.
Such other responsibilities which may be considered specific to the individual program.
9
OVERVIEW OF ROUNDS AND TEACHING
Rounds are held daily and offer residents an exposure to radiology and related teaching topics in
didactic and case based format. Rounds are attended by staff radiologists and in most cases led by
that person. There are opportunities for residents to develop teaching and presentation skills
through “subspeciality” and “resident grand round” sessions. Residents are taught the essentials of
radiology case discussion including the presentation of case material and the approach to
evaluating this material. Cased based teaching offers residents an opportunity to develop
consultative skills necessary to practice radiology and prepare for the Royal College examinations.
MONDAYS
4:00 – 5:00 pm
Resident SUBSPECIALITY ROUNDS organized by Staff/Resident
ELIVE


All residents freed from clinical duties for this time slot
Residents present cases in Power Point format around a topic
selected by them and the participating staff radiologist.
TUESDAYS:
12:00 – 1:00 pm
INTERESTING CASE ROUNDS (ICR) at each hospital for staff
and residents at that location (time may vary from institution to
institution):
HSC interesting case rounds 12 - 1 pm
St. Clare’s interesting case rounds 12 - 1 pm
Residents will attend these rounds and bring interesting cases in
Power Point format with prepared discussion.
Residents attend the rounds at the site that they are rotating
through (Janeway resident may attend General Hospital rounds).
Residents and/or staff radiologists will present cases to the
residents in attendance. The resident presented with the case will
offer a description of the images provided, provide a differential
diagnosis and offer further management suggestions. Staff
present for rounds will ensure this is done in a concise and
efficient manner offering assistance and feedback as necessary
to complete the case. It is the goal that each resident in
attendance be shown a case.
LAST TUESDAY OF THE MONTH: “PHYSICS WITH DR. KENDALL”
WEDNESDAYS:
ACADEMIC HALF DAY: 1:00 – 5:00
ALL RESIDENTS FREED from clinical duties.
All residents will go to the designated hospital for that week.
10
Residents are divided into junior and senior groups and each group is
assigned a location and staff person. Teaching material is prepared
and presented by staff radiologists. Topics are selected to cover topics
from the radiology curriculum. This will usually take the form of a
didactic lecture component. The lecture will often contain case based
examples to demonstrate the topic teaching points. Cases presented
by staff are routinely taken by individual residents in a format similar to
the ICR rounds outlined above.
THURSDAYS:
12:00 – 1:00 pm
4-5 pm (JW days)
Staff Subspecialty rounds at Health Sciences Centre or St. Clare’s
Mercy Hospital. ALL RESIDENTS ATTEND.

ELIVE
These rounds are topic based as are the Monday subspecialty
rounds. The difference is that all teaching material and cases are
prepared and presented by a staff radiologist scheduled.
 These rounds will often reflect a topic in a core area of radiology.
It may also be an opportunity for residents to be exposed to
subspecialty interests of the staff radiologist.
FRIDAYS:
12:00 – 1:00 ELIVE
4:00 – 5:00 PM
Resident Grand Rounds OR
Fundamentals of Diagnostic Radiology OR Resident Grand Rounds
RESPONSIBILITIES OF RESIDENTS:
1) If you cannot present case/topic material on your assigned time you must arrange a
switch with someone else. You must then inform Margie/Jennifer so that an email can
be sent to inform everyone of the change.
2) Rounds must be discussed with assigned staff several days before rounds are
presented.
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JOURNAL CLUB:
Journal Club is an opportunity for residents to practice critical appraisal techniques as they pertain
directly to radiology. Journal Club is held approximately every four weeks and, generally, two
papers are discussed during a session. Staff radiologists with specialty interest in the field covered
by the paper are asked to attend sessions. Papers and topics are chosen by residents in
consultation with a staff radiologist. These papers must offer some educational value to residents.
The paper must be amenable to critical appraisal. Typically such papers tend to be found in
scientific journals such as The American Journal of Radiology or Canadian Journal of Radiology for
example. Articles of a review nature typically do not lend themselves to critical appraisal unless
they consist of a meta-analysis in which case they may be more complex. While such review
articles are of great interest in the practice of radiology they are better reserved for presentation in
the context of other rounds/conferences.
CRITICAL APPRAISAL COURSE:
A course in Critical Appraisal and Research Methodology is held each year. This is coordinated
through the Department of Medicine and involves other faculty from Clinical Epidemiology. This
takes place during Winter/Spring of each academic year.
PHYSICS COURSE:
An “in-house” Physics course is currently organized and run by Dr. Edward Kendall. Physics
teaching scheduled for the last Tuesday of every month at 12:00 noon. A more intensive physics
exposure is provided in the “Physics Boot Camp” annually. This is usually held in late summer or
early fall and offers an introduction to new residents and a review for more senior residents. Dr.
Kendall is very approachable and offers his time to senior residents preparing for their American
Board exams. He will typically hold a question and answer session with residents.
DEPARTMENTAL MANAGEMENT COURSE:
A Departmental Management Course is presently being initiated. Details regarding this course,
which will be run in conjunction with the Technical Director, Department of Diagnostic Imaging,
Health Sciences Centre, will be forthcoming.
VISITING PROFESSOR PROGRAM:
Each year, 2 – 3 visiting professors spend 2-3 days each with residents providing small group
teaching sessions and mock oral examinations. Guest professors are invited to speak to staff in
addition to holding teaching sessions with residents. This offers an invaluable opportunity for
residents to learn a fresh perspective from a range of excellent radiologists practicing throughout
North America.
ETHICS TRAINING:
12
As per Royal College requirements, Ethics training is a part of our radiology residency program.
This will involve teaching, videotapes, care-based discussion, and review of journal articles. Dr.
Fern Brunger and Dr. Christopher Kaposy, Memorial University Ethicists, are available to speak
with residents and are involved in ongoing ethics teaching. There are approximately four sessions
per year. This will be in addition to day-to-day discussion. Also, please refer to the Royal College
Policy regarding “Physicians and Industry – Conflicts of Interest”. Ethics has an online course for
HIC in PGY1 year.
COMMUNICATIONS TRAINING:
A didactic presentation of reporting will be made early each academic year. Reporting formats will
be reviewed along with discussion of legal obligations. This will be in addition to day to day review
of resident reports. Please see below guidelines. Further, residents receive ongoing training as
they review cases with staff radiologists and dictate their findings. Staff radiologists review all
resident reports and will offer feedback as necessary. Feedback early in training is strongly
encouraged to help guide residents in proper reporting technique.
FUNDAMENTALS OF RADIOLOGY SERIES:
This lecture series has become popular with residents of all levels of training. It is a lecture based
series that began informally to assist new residents in development of an academic base for
radiology training. It attempts to guide residents through the core chapters of a major radiology text,
“Fundamentals of Diagnostic Radiology”, By Brandt and Helms. All residents entering our program
are presented with a complimentary copy of this text book at orientation. While a great introduction
to new residents it serves as a refresher for more senior residents that wish to attend.
ETIQUETTE
Attendance at rounds and lectures is mandatory for radiology residents to ensure maximal
exposure to curriculum. Attendance records are kept.
Be punctual! Residents have priority to attend departmental rounds and teaching. It is the staff
radiologist’s responsibility to cover radiology services during this period.
Speakers spend time preparing for lectures and rounds and will not be encouraged to improve their
teaching material if attendance is low. Participate and be enthusiastic. Resident’s will select a staff
person annually who has provided the most educational value. This staff will receive a teaching
award at an annual social event.
Contribute to rounds! This will benefit fellow residents presented with the case and benefit your
learning through case preparation. Collect cases during your rotation. Cases are to be prepared in
Power Point format with a brief summary of findings and discussion of the main learning points.
RESIDENT CALL DUTIES
13
Radiology Residents at Memorial University share call duties with staff radiologists. There is a
graded system of increasing responsibility on call. The frequency of call varies over the course of
residency training but has not been > 1 in 7 recently. Call in our program is categorized as “home
call” and not “in house”. The responsibility for creating the resident call schedule falls with the chief
resident. This is a fair process and includes the input of all residents where possible.
Junior residents entering the program at the PGY2 level initially have no independent call duties.
Exposure to call is structured to allow residents time to obtain the necessary radiology skills to
function in a first call capacity. All PGY2 residents will rotate through ultrasound, emergency, body
CT, Neuro CT blocks before any first call duties are assigned. During this learning period residents
at the PGY2 level will shadow senior residents on call (3 months). This will give residents an
opportunity to watch and learn as senior residents field pages, consult with clinicians, communicate
with radiology technologists, oversee imaging studies, review these studies and report to the
ordering physician. This low stress experience is extremely valuable.
Following a “shadow call “period the resident will begin a “buddy call” phase (4 months). For a
period of 2 months the PGY2 resident will carry the on call pager and report directly to a senior
resident who reviews all studies with the junior resident in hospital. During the next 2 months the
junior has backup from the senior who will assist as needed. Junior residents are strongly
encouraged to seek assistance if there are any concerns.
During the initial months on service PGY2 residents attend lectures by staff on emergency-related
topics. In the late fall the PGY2 resident will be evaluated with an emergency OSCE examination
covering many areas within radiology. Upon successful completion of this exam (PASS mark 70%)
and following successful completion of core radiology rotations the resident will be ready to begin
first call duties with staff backup. While the resident begins first call duties there is staff assistance.
Residents at all levels of training are encouraged to seek the assistance of staff when concerns or
problems arise. Staff are very approachable and readily available on call! Staff radiologists are
committed to a process of graded responsibility and to resident education 24 hours a day.
Summary of graded call responsibilities:
3 months shadow call
2 months buddy (senior in house reviewing all studies with the junior resident)
2 months buddy (senior home call and reviews studies as needed)
After this period the resident is on call with staff backup.
ON CALL REPORTING POLICY
Residents engaged in on-call duties are expected to review imaging studies in a timely fashion and
to provide a report of the findings to the ordering physician. This report must be issued verbally to
the ordering physician and/or physician responsible for care of the patient in question. A typed
report of major findings must also be completed and accompany the imaging study on the PACs
system for review by consultants involved in the case. Post call duties include review of cases done
on call with the staff radiologist on call and the dictation of a completed radiology report using the
Speech Q voice dictation system.
POST CALL POLICY
14
A resident shall be permitted to be relieved of his/her duties at 1200 hours of a regular work day
which follows the in-hospital duty period after a handover of patient care responsibilities.
Residents are encouraged to participate in teaching post call when they have not been called into
the hospital to evaluate a patient after midnight.
DIAGNOSTIC RADIOLOGY REPORTS– Prepare an Informative and concise report
Communication is a critical component of the art and science of medicine and is especially
important in Diagnostic Radiology. Diagnostic Radiology is one of the most important consultative
services in medicine. This standard has been largely based on the ACR guidelines, which we
acknowledge.
The final product of any consultation is the submission of a report on the results of the consultation.
In addition, the diagnostic radiologist and the referring physician have many opportunities to
communicate directly with each other during the course of a patient’s case management. Such
communication should be encouraged because it leads to more effective and appropriate utilization
of Diagnostic Radiology in addressing clinical problems and focuses attention on such concerns as
radiation exposure, appropriate imaging studies, clinical efficacy, and cost-effective examinations.
In order to afford optimal care to the patient and enhance the cost effectiveness of each diagnostic
examination, radiological consultations ought to be provided and radiographs interpreted within a
known clinical setting. The CAR supports radiologists who insist on clinical data with each
consultation request. This standard is based on the Communications Standard of the American
College of Radiology.
A. The Diagnostic Radiology Report
An authenticated written interpretation should be performed on all radiographic (imaging)
procedures. The report should include the following items:
1. Name of patient and another identifier, such as birth date, pertinent ID number, or
hospital or office identification number.
2. Name of referring (attending) physician:
(a) Name of most responsible physician
(b) Names of other physician(s)
Rationale: Quality control.
3. Name of type of examination.
4. Date of dictation:
Rationale:
Quality control.
5. Date of the examination and transcription:
15
Rationale:
To permit tracking of the report.
6. Time of the examination (for ICU / CCU patients):
Rationale:
single day.
To identify multiple examinations (e.g., chest) that may be performed on a
7. Body of the report
The effective transmission of radiographic information from the radiologist’s mind to the
clinician constitutes the purpose of the report. The report should be clear and concise.
Normal or unequivocally positive reports can be short and precise. Whenever indicated,
the report should include:
(a) Procedures and Manuals:
Include in the report a description of the procedures performed and any contrast
media (agent, concentration, volume, and reaction, if any), medications, catheters
and devices, if not reported elsewhere.
Rationale: To ensure accurate communication and be available for future
reference.
(b) Findings:
Use precise anatomical and radiological terminology to describe the findings
accurately.
(c) Limitations:
Where appropriate, identify factors that can limit the sensitivity and specificity of the
examination.
Comment: Such factors might include technical factors, patient anatomy (e.g.,
dense breast pattern), limitations of the technique (e.g., chest examination for
pulmonary embolism), incomplete bowel preparation (e.g., barium enema for
neoplasm), wrist examination for carpal scaphoid injury, or skeletal examination for
detection of stress fracture.
(d) Clinical Issues:
The report should address or answer any pertinent clinical issues raised in the
request for the imaging examination.
Comment: For example, to rule out pneumothorax, state: “There is no evidence of
pneumothorax”; or to rule out fracture, “There is no evidence of fracture”. It is not
advisable to use such universal disclaimers as “the mammography examination does
not exclude the possibility of cancer”.
(e) Comparative Data:
Comparisons with previous examinations and reports when possible are part of the
radiologic consultation and report and, optionally, may be part of the “impression”
section.
8. Conclusion of Diagnosis:
16
(a) Each examination should contain a “conclusion” section unless the study is being
compared with other recent studies, and no changes have occurred during the
interval, or the body of the report is brief.
(b) Give a precise diagnosis whenever possible.
(c) Give a differential diagnosis when appropriate.
(d) Recommend, only when appropriate, follow-up and additional diagnostic radiologic
studies to clarify or confirm the impression.
B. Written Communication
An authenticated written interpretation should be performed on all radiographic (imaging)
procedures. The report should include the following items:
1. The timeliness of reporting any radiologic examination varies with the nature and urgency
of the clinical problem. The written radiological report should be made available in a
clinically appropriate, timely manner.
2. The final report should be proofread carefully to avoid typographical errors, deleted
words, and confusing or conflicting statements, and signed (authenticated) by a
radiologist, whenever possible.
Comment: Electronic or rubber-stamp signature devices, instead of a written signature,
are acceptable if access to them is secure. The signature of the radiologist who dictated
the report should appear on the report. If this is not possible, the initials or name of the
radiologist who dictated the report as well as the initials or name of the radiologist who
signed it should appear on the report.
3. A copy of the final report should accompany the exchange of relevant radiographic
examinations from one health professional to another health professional.
C. Direct Communication
An authenticated written interpretation should be performed on all radiographic (imaging)
procedures. The report should include the following items:
1. Radiologists should attempt to coordinate their efforts with those of the referring
physician in order to best serve the patient’s well being. In some circumstances, such
coordination may require direct communication of unusual, unexpected, or urgent
findings to the referring physician in advance of the formal written report. Examples
include:
(a) The probable detection of conditions carrying the risk of acute morbidity and/or
17
mortality which may require immediate case management decisions.
(b) The probable detection of disease with non-acute morbidity or mortality sufficiently
serious that it may require prompt notification of the patient, clinical evaluation, or
initiation of treatment.
2. In these circumstances, the radiologist – or his/her representative – should attempt to
communicate directly (in person or by telephone) with the referring physician or his/her
representative. The timeliness of direct communication should be based upon the
immediacy of the clinical situation.
3. Documentation of actual or attempted direct communication is appropriate in accordance
with department policy, legal advisability, understanding with the referring physician, and
individual judgement.
4. Any discrepancy between an emergency or preliminary report and the final written report
should be promptly reconciled by direct communication to the referring physician or
his/her representative.
NOTE:
This standard is structured with statements of principles followed by rationales or
comments. Only the principles define the range of suggested practices. The
rationales or comments serve only to clarify the principles
SUPERVISION OF RESIDENTS
The supervising radiologist has a dual professional responsibility to provide appropriate patient
care and to provide education for trainees. There must be a careful assessment of the
responsibility delegated to the trainee. The resident has a dual responsibility to ensure patients
(and their families) for whom they are providing care know they are on a teaching unit and to keep
attending and consulting physicians informed about their patients.
ATTENDING RADIOLOGIST RESPONSIBILITIES
It is the responsibility of the attending physician to:
1.
Review the examinations and procedures with the resident in a timely manner. This
includes:
•
•
•
•
A discussion of the findings and their significance to patient management.
Involvement in major decisions relating to diagnosis and management.
Involvement with the planning and performance of procedures including direct
supervision when required by patient safety or requested by the trainee. Trainees should be
assisted directly by staff commensurate with their level of training.
Identification of the main teaching points of a case requiring educational emphasis.
18
2.
Be accessible (ex. available by pager or phone at all times).
RESIDENT RESPONSIBILITIES
It is the responsibility of every resident to:
1.
Identify oneself as a resident and inform patient (or family) that they are on a teaching unit
and that patient care is a team approach under the supervision of the attending physician.
2.
Notify the supervising radiologist, or consulting physician , as appropriate when:
• a patient’s condition is deteriorating,
• The diagnosis or management is in doubt,
• A procedure with possible serious morbidity is planned.
3. Notify the attending or consulting physician of any abnormal imaging results that may need
urgent management or may significantly affect current patient management.
4. Record in writing on the patient’s report the notification of the attending or consulting physician.
PROGRAM OUTLINE
BY NUMBER OF MONTHS PER YEAR (1 MONTH = 4 WEEKS)
19
FOLLOWING 2010 THE NEW ROYAL COLLEGE REQUIREMENTS WILL BE APPLIED.
PGY2:
1 month
2 months
2 months
2 months
2 months
1 month
1 month
2 month
Gastrointestinal/GU Radiology
Musculoskeletal Radiology
Chest Radiology
Ultrasound
Neuroradiology
Pediatrics
Emergency
Body
13 months
2nd YEAR:
3 months
2 months
1 month
1 month
1 month
2 months
1 month
1 month
1 month
13 months
Angiography and Interventional Radiology
Nuclear Medicine
Ultrasound
Neuroradiology/ENT
Body Imaging
Chest Radiology
Mammography
MRI(Body/Neuro)
Musculoskeletal
3rd YEAR
1 month
1 month
1 month
2 months
2 months
1 month
1 month
1 month
1 month
1 month
1 month
Chest/Cardio Thoracic Radiology
Musculoskeletal
Body Imaging
Mammography
Pediatrics
Ultrasound
Neuroradiology
Obstetrics
Elective
AFIP
Rural – Corner Brook
13 months
4th YEAR
1 month
1 month
Ultrasound
Body Imaging
20
2 months
1 month
1 month
1 month
1 month
1 month
1 month
1 month
1 month
1 month
Neuroradiology
MRI/body
OBS
Chest Radiology
Musculoskeletal Radiology
Elective
Selective
Mammography
Pediatrics
Nuclear Medicine
13 months
PROGRAM OUTLINE BY # OF MONTHS PER ROTATION
1st Year
2nd Year
3rd Year
4th Year
PGY 2
PGY 3
PGY 4
PGY 5
GI
1
0
0
0
1
Chest / CVS/CardioThor
2
2
1
(Card/Thor)
1
6
Musculoskeletal*
2
1
1
2
6
AFIP
0
0
1
0
1
Nuclear Medicine**
0
2
0
1
3
Angio / Interventional
0
3
0
0
3
Elective / Selective
0
0
1(Elec)
Neuroradiology/Neuro/ENT
2
****1Neuro/ENT
1 Neuro
1
**** 6
Body Imaging
2
1(****+1 MRI
Body/Neuro)=2
1(inc. 2
wks. MR)
1
6
Ultrasound
2
1
1
1
5
Mammography***
0
1
2
1
4
Pediatrics
1
0
2
1
4
MRI
0
1(****Body/Neuro)
0
1(MR/Body)
2
Emergency
1
0
0
0
1
Obstetrics
0
0
1
1
2
Rural
0
0
1
0
1
ROTATION
TOTALS
21
1 ea. E/S = 2
3
* ER/NUCS/Body rotations includes some MSK
**Residents wishing to write the American Board examinations must do additional elective
time in Nuclear Medicine.
***Includes Breast Ultrasound & MR
PGY1 ROTATIONS
DIAGNOSTIC IMAGING
MEMORIAL UNIVERSITY OF NEWFOUNDLAND
Emergency ………………….. 4 weeks
General Medicine ................. 4 weeks
CTU’s ................................... 4 weeks
Rural Obstetrics .................... 4 weeks
Wards Pediatrics .................. 4 weeks
OPD Pediatrics ..................... 4 weeks
General Surgery ................... 4 weeks
Subspecialty Surgery ............ 4 weeks
Electives ............................... 4 weeks x 2
Selectives* ........................... 4 weeks x 2
Radiology ……………………. 4 weeks
*Choose any two of the following clinical rotations:
•
•
•
•
ICU (St. Clare’s/HSC)
CTU4 (Health Sciences Centre)
General Surgery
OBS/GYNE US
22
•
Radiation Oncology
Vacation = 4 weeks
Revised October 2010
PGY-1 house-staff are encouraged to attend rounds, including Journal Club, if attendance does not
interfere with their clinical duties. Residents in PGY1 year have half day teaching on Fridays and
are encouraged to attend any rounds held at that time in the radiology department. The
Fundamentals of Radiology lecture series is a great introduction to residents entering the radiology
program.
During PGY1, residents are informed of this site through the Postgraduate Office. This information
is also on One45 and is linked to each of the individual rotations.
In addition, PGY1 Diagnostic Imaging residents are encouraged to attend rounds in Diagnostic
Imaging especially Friday Rounds and all Physics teaching. PGY1 residents should complete the
on line ethics course (www.pre.ethics.gc.ca/english/tutorial/) during this period.
RESIDENT EVALUATIONS:
Background:
Evaluation is an essential part of our Residency Program. It is meant to be a process of continuous
communication. Evaluations from residents are an important reference for program improvement.
Process of Evaluation:
1. At the beginning of a rotation, you must discuss rotation objectives with your preceptor(s).
2. At the end of the rotation, a summative evaluation should be completed and discussed and the
electronic form validated by you.
What is WebEvaluation?
WebEval is an online web evaluation system. It was created by One45 Software for both undergraduate
and postgraduate university programs.
Core Benefits of WebEval:
23
•
•
•
•
•
Improve workflow efficiency
Enhance communications across all levels
Centralize student, resident and faculty information
Identify trends for decision making
Better service students, resident and staff
Benefits for Electronic Evaluation:
•
•
•
•
•
•
Automate the sending, receiving, and collating of evaluations
Evaluate rotations, courses, academic half-day, teaching rounds, residents, students, and faculty
Establish low performance flags to identify those students and residents having problems
Collect valuable research data with surveys
Generate email reminders for overdue forms
Display photos on the forms
How does it work?
•
•
•
You will receive e-mail reminders with username and password information to complete evaluations
online. Your login information is confidential.
You will need to complete the faculty and rotation evaluation
Once forms are completed and confirmed they will be stored in resident file.
If you notice any errors in your personal information or have any trouble accessing the site please contact
the administrator Ms. Margie Chafe, at [email protected] or 777-7165.
Examples of Resident E dossier Account:
http://www.one45.com/help/postgradAdmin/eDossres.html
GUIDE TO RESIDENT EVALUATION
DEPARTMENT OF DIAGNOSTIC IMAGING
The goal of our residency training program is to ensure that our residents receive the best possible
training to master the knowledge, skills and attitudes required of our specialty. A number of
evaluation tools will be used to provide feedback, and to judge and measure performance.
Detailed and timely feedback allows a trainee’s program to be enhanced in any area of weakness.
If problems occur, the resident can be informed early and can be provided with adequate
opportunity for remedial assistance.
This document identifies the evaluation system and guidelines for our Department. It was last
reviewed by the RTC in June, 2010.
EVALUATION TOOLS
24
ITEM
MINIMUM PERFORMANCE STANDARD
ITER (end of rotation)
“at expected level”, overall and on
PGY2, PGY3, PGY4, PGY5
each section of ITER
2.
End of rotation Test
PASS (usually 70% or above 30th percentile)
3.
ACR Written Exam
at least 20th percentile for level
1.
PGY2, PGY3, PGY4, PGY5
4.
5.
Bi-annual Oral Exam
70% overall – scored for each level, based on
PGY2 (2nd half), PGY3, PGY4
Royal College guidelines -Pass
PGY5
Fail - (borderline: 68-69; 67 – below)
Bi-annual OSCE Exam
Overall Pass for level
(70% or higher PGY5, 60% or higher PGY4, 50% or higher
PGY3, 40% or higher PGY2).
6.
Research Requirement
Completed by end of PGY4 year
CONTINGENCIES FOR FAILURE TO MEET DEFINED MINIMUM PERFORMANCE STANDARDS
Rarely do residents fall below the minimum performance standards of the Department, but if this
should occur, the resident, the faculty and the Department members responsible for the training
program need to understand the program which will be structured for the resident.
In general, if a resident’s weakness is focused then the resident will be assigned extra assistance
by the rotation supervisor. If there is a more general or significant problem documented, a more
structured program of Departmental assistance will be assigned under the supervision of the
Program Director. Continued difficulties which necessitate a change in the usual program of
resident rotations will generally require a more formal program of remediation which will be
structured and monitored under guidelines of the post graduate department of the Faculty of
Medicine and residency training committee. This may lead to interruption in the normal promotion
through residency.
25
1.
ETHICS AND CONDUCT: A resident can be recommended for dismissal by the Program
Director, subject to approval by the Resident Training Committee if he/she is found to have
violated the University Codes of Ethical Behavior, the Code of Ethics of The College of
Physicians and Surgeons of Newfoundland and Labrador, or the Code of Ethics of the
Canadian Medical Association. A resident can be recommended by the Program Director for
suspension for improper conduct, pending a hearing and formal review, if the conduct is
such that the continued presence of the resident in the clinical setting would be potentially
hazardous to persons or to the academic function of the training program. Faculty of
Medicine guidelines will be followed in all such matters.
2.
Research: Each resident will design, conduct and complete a research project or
departmental audit supervised by a qualified individual, usually a staff radiologist, other staff
physician or a basic scientist (Ph.D.) approved by the Residency Program Director. This
project is to be presented at the NLAR (Newfoundland and Labrador Association of
Radiologists conference) or a relevant conference approved by the Program Director.
Each resident will complete a second such project or get permission to expand on an
existing project for the purposes of publication or presentation at a relevant meeting or
conference. An acceptable alternative to completing a second project will be the completion
of a presentation, consisting of a short review of a radiology topic, for the NLAR
(Newfoundland and Labrador Association of Radiologists conference).
If a resident fails to complete the Research requirements to the satisfaction of the
Department and Research director by the end of PGY4, the resident will be allowed to
advance to the PGY5 year on the condition that the Research requirement will be completed
within four months. If the resident does not complete the research within this four month
extension, this will be grounds for recommending notification to the Royal College that
Department Training requirements have not been met and can be waived at the discretion of
the Program Director.
3.
Levels PGY2, PGY3, PGY4:
A)
If a resident is evaluated “below the expected level” on two ITER sections (Medical Expert,
Scholar, Advocate, etc…) or end of rotation tests within the same year, the resident will be
assigned remedial assistance (relevant to the section of weakness) by the Program Director
in consultation with the Residency Training Committee and/or rotation supervisors.
B)
If a resident, on any one of the following evaluation tools is evaluated
a) “below the expected level” or “unacceptable” on three sections of ITERs
OR
b) “borderline” or “fail” overall on any ITER
OR
26
c) receives a grade on the ACR below the minimum standard
OR
d) receives a grade on the Department Oral below the minimum standard
OR
e) receives a grade on the Department OSCE below the minimum standard
The resident will meet with the Program Director to discuss the problem(s). The resident may be
assigned remedial work which could include any combination of assigned reading or academic
review, work with an assigned mentor or repeat exams at the discretion of the Program Director.
This remedial work could extend up to three months and will be evaluated under the direction of the
Program Director.
If within one year of commencing this Departmental remedial work the resident receives a second
evaluation below the minimum performance standard the resident may be recommended for a
more intensive program of remedial assistance.
If within one year of commencing the Departmental remedial work the resident receives a third
evaluation below the minimum performance standard, the resident may be recommended to a
formal program of remediation, or remediation with probation, or probation by the Program Director
with the guidance of the Residency Training Committee. This recommendation will be subject to
review by the Post Graduate Department of Memorial University. The remediation program and
evaluation guidelines will be indicated in writing prior to the start of the program.
If this remediation program is successful, the resident may be recommended for continuation in the
program at the appropriate level. If this program is not successful, the resident will be
recommended for further remediation, remediation with probation or probation. Credit for
remediation rotations may not be given if the goal(s) of the remediation is not attained.
Remediation with probation or probation implies the possibility of refusal for promotion or of
dismissal if the resident is unwilling or unable to meet the required standards of performance. This
is to subject to review by the Post Graduate Department of Memorial University of Newfoundland.
If a resident successfully completes a program of remediation but within the next twelve months
falls below the minimum performance standard on any evaluation, the resident will again be
recommended for a further formal program of remediation, remediation with probation, probation or
dismissal.
PGY5: Failure to meet the minimum performance standard on any ITER overall or other evaluation
item will be grounds for an immediate review of training performance and recommendation for
formal remediation. Failure to meet the minimum performance standard on two evaluations in the
PGY5 year will be grounds for recommending notification to the Royal College that Department
Training Standards were not met and for recommending the resident not proceed to the college
27
exams. This will also be grounds for recommending the resident repeat the PGY5 year. This will
be at the discretion of the residency program director and/or residency training committee.
If unusual or extenuating circumstances exist concerning a resident subject to any of the above
items, the Program Director with the approval of the Residency Committee and/or post Graduate
Department can alter the recommendations listed.
Any decision by the Program Director to recommend remediation for, probation for, or dismissal of
a resident must be made in consultation with, and approval by, the Residency Training Committee
of the Department of Diagnostic Imaging. Any decision by the Program Director to recommend
remediation for, probation for, or dismissal of a resident must be made in consultation with, and
approval by, the Residency Training Committee of the Department of Diagnostic Imaging. The
Chair of the Department and Post Graduate Department shall be informed of all decisions.
Any decision to recommend remediation for, probation for, or dismissal of a resident must be
reviewed and approved by the Postgraduate Education Evaluation Board of Memorial University.
Any decision to dismiss must also be approved by the Chair of the Department and by the
Associate Dean, as indicated in University Guidelines.
Any decision by the Board may be appealed by a resident according to the University’s Guidelines
for appeals.
EVALUATION PROCESS
DEPARTMENT OF DIAGNOSTIC IMAGING
1. All trainees should be provided with a copy of the Department Guidelines for Resident
Evaluation at the beginning of their PGY2 Year and at any time these standards are changed.
2. All trainees should be provided with a copy of “Guidelines for Evaluation of Residents of the
Faculty of Medicine of Memorial University”.
3. A resident should receive a copy of and/or provided with verbal details of all evaluation results
or this should be provided on request to the trainee. All such results should as well be kept as
part of the resident’s University file.
4. The Resident Evaluation form (ITER) should be designed and adopted by the Residency
Training Committee. The form must be accompanied by guidelines to assist the supervisor(s) in
marking individual items. Comments should be made on any specific areas of performance,
which contribute significantly to the evaluation, especially in areas of weakness. For the
purpose of completing the form, appropriate medical and non-medical personnel should be
consulted about the resident’s performance. If a problem is identified at any point during a
rotation, the supervisor must bring this to the attention of the resident promptly.
5. At the midpoint of any rotation which is 2 months or longer, the supervisor must provide the
resident a mid-way evaluation.
28
6. At the end of every rotation, an evaluation (ITER) must be completed. The supervisor should
discuss this evaluation with the resident preferably before the end of rotation or as soon
thereafter as possible. Residents should approach rotation supervisors requesting this by the
end of the rotation or shortly thereafter if they are not aware of arrangements to meet staff.
7. The resident will be given a reasonable time to consider and comment on the evaluation.
8. Completed evaluation forms are to be reviewed by the program coordinator within one month of
the end of rotation. This will allow the program coordinator to be aware of and if appropriate,
address problems in the rotation or relating to the residents’ performance in a timely fashion.
Any supervisor providing a “borderline” or “failed” evaluation is required to speak directly to the
program coordinator before the end of rotation. One45 evaluation systems alerts the program
director to Low Performance grades.
9. Completed evaluation forms are to be sent to the administrative office within one month of the
end of rotation. One45 evaluations are automatically forwarded to administration for review
once completed.
10. All evaluations are reviewed by the Program Director.
11. Results of ACR Exams, Department Exams, the Physics Exam, and completion of the
Research requirement will be sent to and reviewed by the Program Director.
12. A Resident Evaluation Committee, which will be a subcommittee of the Residency Training
Committee, under the leadership of the Program Director, shall be responsible for all matters
pertaining to the Standards, Process, Review and Promotions of the residents.
13. The Resident Evaluation Committee will be appointed annually by the Program Director with
the approval of the Residency Training Committee. Members will include the Program Director,
residency training committee members and one resident representative (preferably a senior
resident).
14. The Resident Evaluation Committee or Residency Training Committee shall meet/communicate
i)
once a year to consider and approve all resident promotions for notification of the
Post-Graduate Office.
ii)
at any time that the performance of a resident requires consideration of assistance,
remediation or program modification.
15. When a resident’s performance falls below the minimum evaluation standards, the Program
Director shall meet with the resident and review the performance issues. The Program Director
may call a meeting of the Resident Evaluation Committee to discuss a program of remedial
assistance which will be outlined to the resident. A report on this program shall be presented to
the Residency Training Committee at the next regularly scheduled meeting and/or discussed
with individual committee members when no meeting is pending.
16. Any recommendation for formal remediation under the University guidelines shall first be
considered by the Resident Evaluation Committee, but shall then be presented to and approved
29
by the Residency Training Committee. The Chair of the Department shall be informed of all
decisions.
17. The notification, approval and process of Remediation shall follow the Guidelines outlined by
the University.
Conflict Resolution and Appeals
If a resident has a concern he/she should address it at earliest convenience according to the
following process:
Staff member +/- chief resident support
Site Coordinator
Program Director
Resident Representative/Chief Resident
Training Committee
Chair
Postgraduate Dean
Dean
University Senate
The Program Director can be approached directly as deemed appropriate by the resident.
30
APPEAL PROCEDURE FOR AN UNSATISFACTORY EVALUATION
In the training of Radiologists the Memorial University Radiology Residency Program aims to
provide an educational program which will be adequate to meet the trainee’s educational and
professional needs. We strive to evaluate the trainees to ensure that they have successfully
acquired the required knowledge, skills, attitudes, behaviors and ethical standards to practice
competently.
While regrettable, there may be the occasional trainee whose academic performance or
professional behavior is unsatisfactory requiring that the resident’s program be extended or that the
training be terminated. It is essential that the evaluation systems be valid and appeal mechanisms
fair. Residents may appeal an evaluation through their Residency Training Committee. Residents
should be aware that an appeal process may or may not support their case.
PATHWAY FOR APPEALS
Where applicable, residents are urged to first discuss an evaluation or concern with the rotation
supervisor.
The resident then may appeal first to the Program Director in order that the appeal can be reviewed
by the Residency Training Committee. This can be done by the resident alone, the resident
accompanied by the chief resident or staff radiologist of the resident’s choosing. The Residency
Training Committee will convene in a reasonable time not to exceed 2 weeks.
If the resident is unsatisfied with the findings and decision of Residency Training
Committee, an appeal can be made to the Associate Dean, Post Graduate Medical Education, for
the appeal to be heard by the Post Graduate Medical Education Committee. The decision reached
by the PGME Committee will be forwarded to the Program Director. After an appeal to the PGME
Committee the trainee can appeal to the Student Appeal Committee of the Faculty of Medicine,
Memorial University of Newfoundland.
THE RESIDENCY APPEAL PROCESS
If the initial discussion with the supervising faculty and Program Director did not result in
satisfactory resolution of a grievance, the resident may initiate an appeal by submitting a written
letter to the Program Director within one month of the original evaluation. The written appeal will be
brought to the Residency Training Committee at a specially scheduled meeting. Two residents
must be in attendance.
The Program Director or designate will provide a brief introduction for the appeal. A designate will
act on behalf of the Program Director when it is the Program Director’s decision that is being
appealed. In this case, the Program Director will act as a nonvoting committee member. The
31
Program Director or designate will summarize the reasons for the initial evaluation. Following this,
the resident may present his or her case to the RTC or may have an advocate speak on the
resident’s behalf (the RTC must receive advanced notice if a resident will have an advocate at the
meeting). Following discussion, the resident, resident advocate and Program Director (if a
designate is present) will leave the room while remaining committee members discuss the issues
and vote by a closed ballot. The result of the vote will constitute the final decision of the RTC. A tie
vote will be decided in favor of the resident. The outcome will be discussed with the resident in
person as soon as possible. A written statement of the outcome will be sent to the resident,
Departmental Chair and Post Graduate Dean.
A resident who is not satisfied with the departmental appeal can appeal to the Post Graduate
Medical Education Committee through the Associate Dean. Appeals must be submitted in writing
within 10 days of receiving the results of the departmental appeal. The appeal at the Post Graduate
Medical Education Committee will be limited to an assessment of the "justness" of the decision and
whether the process followed at the departmental level supported the decision reached.
The Faculty of Medicine Ombudsperson is Dr. Stephen Lee, a local family physician. His role is that
of a “third person” who can step in if a student has concerns with a program or department head
and feels they can’t deal directly with the concern. The role is not to provide counseling or to
investigate, but to help students identify pathways to take their concerns for answers or action. Dr.
Lee can be reached at [email protected].
32
RESIDENT RESEARCH
DEPARTMENT OF DIAGNOSTIC IMAGING
Requirements and Resources
(August 2010)
Requirement:
A.
At least one completed research project during residency.
B.
A second completed research project OR a short presentation reviewing a topic in or
related to radiology to be presented at the NLAR meeting.
Qualifying project types:
•
•
Prospective or retrospective study
Audit of technique, examination, or procedure
Less Desirable Project Types:
•
•
•
•
Case Reports
Letters to Editors
Case of the Month
Review type exhibits
Definition of completion
•
Presentation at the NLAR Research Day (held annually) and/or presentation at national
or international meeting
•
Formal written submission for publication to a Medical Journal (Follow guidelines for a
uniform requirement for manuscripts submitted to Bio-Medical Journals --Annals of
Internal Medicine 1988; 108.258-265.)
Time
Over the final four years of residency (PGY 2-5) each resident will have an appropriate amount of
time allocated for the completion of a research project. If time is to be taken from clinical rotations
an appropriate leave form must be filled out and submitted to both the residency training director as
33
well as the Clinical Chief for the division in question. This should not exceed 1 day per week in any
clinical rotation or a maximum of 20 days in total not including the July and August ½ day time
period.
Residents are encouraged to use summer ½ day assignments to complete research projects as no
formal teaching schedule is in place at that time.
Residents may also apply to do research electives during their PGY training.
Mentors
All research should be performed in conjunction with a staff person mentor. That person can either
be an active participant in the research project or may simply be available for guidance.
That staff person will be responsible for ensuring the quality and completion of the project and
therefore must be identified when the research project is identified to the University office.
Key Research Contacts within Department of Medical Imaging
All office administrative staff are available for material services related to research projects.
Dr. Kendall’s research assistant will also provide assistance with HIC proposals and material
arrangements. She can be reached through the Office of the Chair.
Services provided to residents:
- type/assist with completion of proposal/consent for Human Investigation Committee
- type/assist with completion of research grant applications, if any
- type/submit manuscripts and abstracts
Dr. Angus Hartery, Program Director
Dr. Benvon Cramer, Professor and Chair, Diagnostic Radiology Academic Program
Dr. Edward Kendall, Professor , Medical Physics, Diagnostic Imaging
RADIOLOGY RESEARCH DOCUMENTATION
All research even if not completed must be documented with the University Radiology
offices.
At the onset of any radiology research project a short description of the project must be
submitted to the Office of the Chair giving details about the project and the staff person that
has agreed to participate in the project. This is used in record keeping.
The Office can also enable coordination of any applications for research funding.
34
FINANCIAL SUPPORT FOR RADIOLOGY RESEARCH
The University has limited funding for assisting Residents to either present or publish their research
at organized meetings but will aim to fully cover presentations up to two per year. Application for
the same must be made in advance prior to submission through the Radiology University office.
Applications for funding should be made up front and well in advance of meeting. Residents are
provided with funding to present at authorized conferences or meetings.
HUMAN INVESTIGATION COMMITTEE
All research projects must be passed through the Human Investigation Committee of Memorial
University. All detailed information including applications, frequently asked questions, and
suggestions on how to fill out the application are available on the web site www.med.mun.ca/hic.
Kathy McKay will assist residents in this process.
It is anticipated that most and eventually all radiology residency projects will qualify for expedited
review and typically this can be turned around in less than one week.
FINANCIAL IMPACT STATEMENT
All research carries limited financial impact on the hosting institution. Therefore a mechanism has
been developed to identify that impact.
Once full approval has been granted by HIC, research proposals are then reviewed by Research
Proposal Approval Committee (RPAC). The primary mandate of this committee is to review
resource utilization for any project to be conducted within the corporation. Review by RPAC
requires submission of a short form, which provides a brief explanation of the project, associated
costs and sources of funding.
All projects are reviewed and approved by the Program Clinical Chair before receiving final full
approval from RPAC.
-
The committee meets monthly
-
It will be the responsibility of the investigator initiating the research project to insure
appropriate institutional and departmental approvals are in place prior to undertaking
any research project.
RPAC Applications are to be sent to:
Donna Bruce, RN
Manager, Patient Research Centre
Level 1, HSC
Phone: (709) 777-7283
(709) 777-6995
35
COMPLETION OF PROJECT
After the project is completed a one page abstract identifying the principal investigators, the design
of the project and the conclusions, if any must be submitted to the Radiology office.
Documentation of all research projects must be provided.
36
GUIDELINES FOR RESIDENT RESEARCH PROJECTS
(Revised: August, 2010)
A Three-Phase Venture:
1.
Proposal:
before commencing any study proposal it must be reviewed by:
- mentor of the research study ( staff person)
If funding is required for the study, application must be made to the appropriate agencies.
Appropriate application must be made to HIC as well as the Hospital Funding Committee. A
draft proposal must also be registered with the Radiology office.
2.
Study:
The actual collection and analysis of data.
3.
Presentation:
Either a written paper for submission to a medical journal or a presentation at the NLAR
Annual Scientific Meeting. A one page summary must also be submitted to the Radiology
office. Projects will be funded if presented in North America or at an authorized international
location. Please confirm with Rhonda BEFORE the submission of abstract.
I.
Proposal
The research proposal is outlined. It is then to be reviewed by the appropriate staff person.
This should achieve several objectives:
a)
learn the correct way to design a small project
b)
help the resident design an achievable goal
c)
documentation must be provided to the radiology office so that possible conflicts or
repeating research projects can be avoided.
d)
after completing these steps the appropriate applications to the HIC as well as
hospital funding committees must be made.
37
II.
Study - Considerations for Designing a Research Project
1)
What is your question? Be specific. (There may be more than one - be very precise in
describing what they are. This is the most important part.)
Do a literature search and read the papers. Has this been done by others? What can
you learn from their work?
2)
What do you expect to find? What other possible answers could there be?
a)
Why is it important to answer this question? What effect will your answer have?
Does it have any clinical (practical) implication?
b)
How are you going to answer this question?
What type of study will this be?
Descriptive: i.e. Find a number of cases of a disease and describe the
findings on imaging modalities.
Pilot Studies
-
feasibility of new technique
-
acceptability of the method to patients and hospital staff
-
quality of images
Comparison of Technique - i.e. Two types of films, two filters, two methods of
labeling, etc. (may not need gold standard)
Diagnostic Accuracy -
assessing a test or tests against a “gold standard” and
possibly comparing them. How will you define your
gold standard. Very Important!!
Clinical Value -
aim to evaluate the contribution of an imaging technique to the
clinical management of a patient, both diagnostic and
therapeutic.
Randomized Comparisons-
outcome after randomization to one or other imaging
techniques
38
Before and After Studies -
study of diagnostic practice before and after
introduction of a major new technology such as
CT/MR etc.
c)
I)
How will you get your patients?
How will you collect your data?
How many patients/cases will you need?
II)
What data will you collect?
Name, DOB, MCP#, etc...
III.
-
collect more rather than less information
-
make sure you answer enough questions to decide if patients have met your “gold
standard” criteria!
-
make notes on why you made a particular decision! (You will forget).
-
design a data chart and do a “pilot” to check you have enough information
-
consider using a computer database and figure out how to code
information
III)
Decide on a time frame! Is this realistic? Who will need to help you get this done?
Are they willing to help? Does this need money?
IV)
What problems and limitations do you anticipate? How can you get around this?
Paper. Write up a proposal - ready for presentation.
a)
Summary. Brief summary.
b)
Background and rationale. Why this study needs to be done. Review of
literature (brief)
c)
Aim of the study. ie. What is the question or questions? (also may be called
objectives)
d)
Hypothesis. What do you expect to find?
e)
Design of the study. Materials (Patients) and Methods.
39
f)
Analysis. How do you expect to analyze your results?
g)
Anticipated problems and limitations
Completion of Project:
Project considered completed when:
-
Presented at Annual Radiology Research Day and/or provincial, national or
international meeting
-
Paper Submitted in written format to the Radiology office. The paper should be written up
following guidelines in “Uniform Requirements for Manuscripts Submitted to Bio-Medical
Journals”, Ann Intern Med 1988; 108: 258-265. It is encouraged that residents submit their
manuscripts for publication. If the manuscript has been published, a copy of the published
article may be submitted to the Research Committee.
Guidelines for Manuscript:
Abstract:
Clearly state the purpose of study and why it is important.
Method:
Basically this is your proposal - written in past tense as opposed to future
tense. For example: Who or what did you study? How did you do it and
What did you do with the information when you got it?
Results:
Present in clear fashion with appropriate use of tables, figures, point out
important trends and findings.
Discussion: Point out any limitations of your study.
What is the significance of your results? If they disagree with others - why?
Sum things up in one paragraph at the end.
40
RESIDENT TRAVEL
FUNDING GUIDELINES
1) Reimbursement for all resident travel must first be approved by the Professor and Chair. If you are
planning to submit a paper for presentation, please discuss funding with the Chair beforehand.
2) If residents are presenting a paper at a Radiology conference in North America, their travel expenses
will be paid up to $3000.00, but please remember that the funding needs to be approved before
submission of your abstract/poster
.
3) Residents are expected to avail of the most economical fares for conference, airfare and ground
transportation to and from the conference site. Memorial University does not reimburse for rental
cars unless they are the most economical means of transportation and rental of vehicles need to
have prior approval before travel.
4) When residents wish to attend a conference where they are not presenting a paper, they can be
funded $750.00 towards their travel, but this must also be approved before travel plans are made.
This amount is currently under review and may be increased.
5) Residents are funded to attend the Newfoundland and Labrador Association of Radiologists (NLAR)
Annual Scientific Meeting held in Corner Brook each year by the Discipline or the NLAR.
6) To clarify the above, a resident will receive money for EITHER Item #2 or #4 above, but not both.
7) Third year residents receive $5500.00 in funding towards their travel costs to the Armed Forces
Institute of Pathology course, and their registration fees of $1600US are paid in advance for them.
8) Rural Rotation Travel. Residents who travel to Corner Brook for their rural rotation will be covered by
the Postgraduate Medical Education Office. When travelling to the Rural Rotation in Corner Brook,
either gas up in St. Johns and along the way, if needed OR gas up along the way and then once you
arrive in Corner Brook that same day. Receipts are mandatory for reimbursement and meals.
Receipts need to be submitted to the Postgraduate Office. Accommodations are paid for by Western
Health providing residents avail of their accommodations.
9) Senior residents receive $1,250 towards travel to a Radiology Review Course in their final year.
IMPORTANT POINTS
1) A Travel Request form must be completed before travel commences (obtain form from Rhonda)
2) Travel Claims must be completed within 10 days of the end of travel. All receipts for expenses must
be retained and submitted. This includes the official airline itinerary with cost, boarding
passes, hotel receipts, taxi/shuttle receipts. A brochure from the meeting must also be
submitted with your travel claim.
41
3) Travel Advances are available for residents.
4) If a travel advance is given, receipts must still be kept and a resident still needs to complete a travel
claim within 10 days of the end of travel.
5) Registration fees for meetings can be paid by the University in advance of the meeting so you
will not be out of pocket for this expense. Residents can provide the details to Rhonda and she
can process the registration though the University.
6) Eastern Health Travel Guidelines: Resident must fully complete their travel request form, sign and
date it, and submit it, along with all necessary supporting documentation, to the PGME office. For
residents travelling to New Brunswick, for core rotations, they must seek reimbursement for the first
half of their travel expenses while in New Brunswick.
OTHER RELEVANT DEPARTMENTAL POLICIES
CONFERENCE LEAVE
•
7 days/year per resident.
SICK LEAVE
•
Contract states 2 days/month – cumulative during each contract year.
completed and submitted to the academic office upon returning to work.
Forms must be
VACATION TIME
•
4 weeks/year.
•
Preferably taken in one-week blocks. No more than one week off per 4 week rotation.
•
At discretion of Administrative Resident, Hospital Chief, and Program Director.
•
If vacation has not been arranged for each year, it may be arbitrarily assigned.
•
Holiday and conference leave forms must be signed and returned to the Chairperson’s office
at least two weeks prior to any leave; if not, we will not guarantee that payroll will continue
the resident's salary during this time off.
•
There must be 2 residents at each site at all times, with the exception of the Janeway site.
•
Please refer to Resident’s contract for further details.
42
CRITICAL INCIDENT AND STRESS POLICY
DISCIPLINE OF RADIOLOGY
Adopted September, 2010
PURPOSE
To establish authority and process to be followed within the Discipline of Radiology in response to a
Critical Incident or Significant Stressor ultimately assisting residents who are involved directly or
indirectly in patient care situations that involve negative outcomes, either real or perceived or
assisting residents confronted with other significant stressors.
SCOPE
This policy will apply to all residents in the Discipline of Radiology as well as any residents or
medical students who are participating in a radiology elective at the time of a critical incident.
DEFINITIONS
Critical Incident (CI) - An occurrence in which the resident is exposed to a negative patient outcome
over which he or she feels they had a direct or indirect influence. This could include a patient’s
death that they personally witnessed or were involved with, regardless of whether they felt they
acted appropriately or not.
Significant Stressor – Any significant stimulus contributing to a level of undue stress on a radiology
resident that is identified by the resident, staff radiologist or other individual which requires attention
to improve the quality of life, quality of work, academic progress, well being of the resident and/or
patient care.
Program Director – The faculty member responsible for the Radiology Residency Program
Staff Radiologist – Radiologist employed by Eastern Health and engaged in resident education.
POLICY AND PROCEDURES
43
Reporting a Critical Incident
A critical incident occurs in which the resident or supervising staff radiologist feels the resident
needs to have a debriefing regarding the event. Either the resident or supervising staff shall be
responsible for identifying the incident to the program director. Examples of CI may include any
adverse outcome during a patient encounter. This would be most relevant to residents on rotations
with procedural components such as interventional radiology.
Reporting a Significant Stressor
A significant resident stressor may be identified by the resident him/herself, the program director or
another individual(s).
Referral and Meeting Guidelines
* The staff person is responsible for referring the resident to the CI/stress process. Referral is made
to the program director by the staff person or resident involved. The referral can also be made by
another health care provider who has knowledge of the event.
* Where possible the referral for CI/stressor must be made within 3 days of the event. In situations
where the effect of the CI/stressor is not immediately obvious, the referral must be made as soon
as possible after the effect becomes obvious. The program director will arrange the meeting.
* The first meeting shall be attended by the program director and the involved resident +/- the
attending staff. The resident may elect to have another staff radiologist or mentor present/involved
if there is a preference. If the resident designates such a staff to assist in the process then the
program director may be excused.
* Further referrals to other experts may be deemed appropriate; the Program Director or
designated staff will be responsible for arranging such meetings with permission of the resident.
* The confidentiality of the meeting is paramount and discussions will not leave the room. The only
documentation shall be that the meeting occurred, who was present, when the next meeting is
scheduled and that all parties are in agreement with what was discussed. This meeting shall not
become part of the resident’s permanent record.
* There must be a follow-up meeting between the program director/other designated staff
radiologist and resident, within 2 weeks to ensure any outstanding issues are resolved and that the
resident is coping with the event. The Program Director or designated staff will arrange this
meeting.
Support Services for Residents Involved in a Critical Incident or facing significant stressors:
The Resident shall be offered or referred for further counselling to one or more of the following
services;
44
* Dr. Scott Moffatt (Postgraduate counselor 553-6216)
* Ms. Rosemary Lahey (Professionals’ Assistance Program 754-3007, 1-800-563-9133)
* Dr. Rick Singleton (Pastoral Care 777-6959)
* Eastern Health’s Employee and Family Assistance Program (EFAP, 777-7777)
* PAIRN, if appropriate
* CMPA, if appropriate
Harassment Policy
A formal policy on Intimidation and Harassment is available through Postgraduate Medical Studies. This
policy also briefly addresses ethics and guidelines of conduct. The web site is:
http://www.med.mun.ca/getdoc/759aa8ce-9b52-4989-bb50-f55c9f4c8a7e/Policy-on-Intimidation-andHarassment.aspx
Support is offered by the office of Postgraduate Medical Studies through their Postgraduate Counsellor, Dr.
Scott Moffatt. Dr. Moffatt is available directly or through the Postgraduate Office. This confidential service is
separate in every way from the residents’ evaluations and the discipline’s assessments of the resident.
Issues which arise among residents include the academic stress of residency, career choice issues,
interpersonal conflict, financial stresses, and personal issues as a resident tries to find balance between
their personal life and their life as a resident. The services are confidential and there is full backup support.
In addition the Postgraduate Medical Studies office has had visiting speakers discussing stress
management.
Memorial University Residency Program Safety Policy:
The Radiology Residency Program is committed to ensuring residency safety. We accept and follow a safety
policy drafted by the Post Graduate Medical Education office. Please refer to this appended safety policy.
Herein the phrase, “the resident”, refers to any person currently enrolled in post graduate radiology residency
training at Memorial University of Newfoundland or any person not enrolled that is authorized by educational
authorities to rotate through the radiology services of Eastern Health.
1. Safety policies of the Memorial University Radiology program reflect the broader safety policies of the
postgraduate office, Eastern Health and Memorial University of Newfoundland. Please refer to each authority for
current policies. Policies of those authorities supersede points 2 through 5 below.
2. Assessment of safety threats in the day to day performance of tasks performed as a radiology resident is left to
the discretion of the resident.
3. Any work place situation deemed a threat is to be avoided at the discretion of the resident until such a time that
the resident has sufficient support from other staff and/or security to proceed.
4. Campus police and civil police are available at 7280 and 911 respectively and should be notified of significant
security/safety risks at the discretion of the resident.
5. Resident travel encompasses a variety of transportation modes potentially used by the resident through the
course of residency training. It is the responsibility of the resident to ensure that travel, in the context of the
45
residency training requirements, is safe in all respects. All travel choices are at the discretion of the resident.
Residents are encouraged to consult relevant agencies or authorities when traveling or planning to travel for
necessary information to aid in the decision process.
Dress Code as per Memorial University Faculty of Medicine
As physicians, along with other health professionals, your principal focus is the client – your patient. Patients
come from a wide range of cultures, diverse economic and educational backgrounds, as well as extremes in
age groups. In addition, they and their families come to us often under a great deal of stress and
vulnerability. It behooves us all to present ourselves as professionals who are sensitive and responsive to
our patient’s expectations regarding appropriate identification, apparel etcetera while on duty.
In general clothing must be clean, proper fitting, comfortable and non restrictive. Beach style clothing, crop
tops, halter tops and revealing clothing are not appropriate. Stiletto heels are also not appropriate.
PROGRAM TRANSFER POLICY
The Postgraduate Medical Education Committee recognizes that postgraduate trainees may wish to change
programs and has developed the following policy and procedure in an attempt to ensure a fair and equitable
process which will work to the benefit of all stakeholders. Although all requests for transfers will be
considered, there must be recognition that not all requests will be granted.
This policy applies only to those who are in positions matched through CaRMS.
PRINCIPLES:
1. Postgraduate trainees should have options if they are enrolled in a program which they feel is
inappropriate for their needs.
2. No program will be required to accept a postgraduate trainee who does not meet the programs'
admission criteria or for whom adequate training resources are not available.
3. All transfer requests will go through the Postgraduate Medical Studies Office. The PGME Office will
facilitate application while maintaining postgraduate trainee confidentiality.
4. The application and approval process will follow the “Procedures for Transfer”.
5. Potential recipient programs will have access to the trainee's original CaRMS application, in- training
evaluations and academic record; with signed authorization of release by the applicant.
6. Approved transfers will occur:
i. January – first changeover in January
ii. July – start date of academic year
7. In order for programs to have an opportunity to review all potential candidates, the deadline for
completed application will be:
i. October 30 - for January transfer
ii. April 30 - for July transfer
8. All trainees will be advised of this policy at orientation and a copy of the policy will be
contained in the PGY I Handbook.
9. Recognizing the potential stresses related to decisions to transfer, all applicants are
46
encouraged to seek counseling through EAP or the Postgraduate Counselor.
(Candidates may be required to seek this following that interview with the Postgraduate Dean).
10. Candidates with return-in-service agreements must clear potential transfers with their
Sponsoring body.
11. Candidates who have received bursaries must clear potential transfers with the Department
Of Health prior to application deadlines.
12. This transfer process is not intended to subvert the CaRMS match.
13. Candidates are not eligible for transfer prior to their PGY I year.
(July 21, 2000)
Eastern Health Policies
The following policies can be accessed on the Eastern Health intranet at:
http://intranet.easternhealth.ca/EH/policies.aspx
-
Requests for Diagnostic Imaging Services
Distribution of Reports
Verbal Reports
Technologists Interpretation of Examinations
Films on Loan
Guest Films-Images
Release of Diagnostic Imaging Reports
Copying of Images
Retention of Records
Patient Registration and Ordering Diagnostic Imaging Examinations
Clinical Research
Emergency Preparedness Responsibilities
Teaching Files
Security of Patient’s Valuables
Dress Code
Retention of Policy Manuals
Stat Diagnostic Imaging Examination Requests
Expiration of Diagnostic Imaging Requests for Walk In Services
Documentation of Non-Service Recipient Workload Units
Coagulation Protocols
Repeat-Reject Analysis
Quality Control-Imaging Equipment
Cancellation-No Show Appointments
Intradepartmental Communication
Documentation of Examination Information
Image Identification
Mission Statement/Principle Functions
Goals and Objectives
CAMRT Code of Ethics
47
-
Organization Chart
Professional Ethics
Professional Qualifications and Registration
Orientation
Educational Support
Staff Scheduling/Workload Distribution
Emergency Standby/Callback
Meal-Rest Periods
Electronic Reporting of Overtime-Callback
Supervision of Students
Hiring of Medical Radiography Graduates Prior to National Examination Results
Emergency Department D.I. Reports
Significant Findings
Signing Reports
Patient Instructions
Patients from Critical Care Areas
Patients Taking Metformin
Transfer of Function Intravenous Administration Contrast
Reaction Drug Tray
Mobile Imaging
Prevention of Contrast Induced Nephropathy in D.I.
Critical Findings
Interpretation of Images
Image Quality
Preoperative Examinations
Immigration Chests
Patient Transportation-Assistance
Use of Safety Straps
Contrast Medium
Infection Control in D.I.
Removal of Collars-Splints-Traction Devices
Documentation Requirements for Intravenous Contrast
Patient Weight Limitations
Verification Checklist for Invasive-Interventional Procedures
Imaging of Female Patients of Child Bearing Age
Gonadal Shielding
Radiation Equipment
Radiation Protection Patients-Public
Radiation Protection-Staff
Inspection of Protective Clothing
Preventative Maintenance
ALARA Principle
Chemical Safety
Diagnostic Imaging Safety
Diagnostic Imaging Safety Orientation, Education and Training
Diagnostic Imaging Safety Inspections and Adults
Diagnostic Imaging Personal Protective Equipment
Scent Awareness
CT Patient Shielding.pdf
CT Multi0Dosing
CT Clinical Training
Virtual Colonography Preparation Kits
48
-
Heimlich Valve Home Care
Requests for Mammography
Routine Views Screening-Diagnostic
Breast Imaging Guidelines
Breast Imaging Protocols
Urgent Diagnostic Mammography Requests
Additional-Supplementary Mammography Views
Consent for Mammography Procedures
Imaging of the Augmented Breast
Image of the Breast with a Defibrillator, Pacemaker or Power Port Present
Localizations Under Mammography Control
Core Biopsy Under Mammography Control
Galactogram
Imaging the Post Lactating Breast
MRI Requests
Protocoling of MRI Requisitions
Scanning Patient Information into PACS for MRI Examinations
Weigh Limit-Size Restrictions for MRI Tables and Magnets
Image Identification-Ultrasound
Documentation Requirements for Reprocessing Ultrasound Probes
49
Recommended Reading
The following is a list of books recommended for reading by residents and staff in radiology in many
programs across Canada. This list might be used to form the basis of a library.
Recommendation
A. GENERAL TEXT:
1. Fundamentals of Diagnostic Radiology:
Brant & Helms .......................................................................................Must Read
2. Radiology, Diagnosis, Imaging and Intervention:
Taveras and Ferruci ..............................................................................Reference Text
3. Merrell’s Atlas of Radiographic Positions and
Radiographic Procedures, Volume I, II, III:
Philip Bélanger ......................................................................................Reference Text
B. CHEST:
1. Diagnosis of Diseases of the Chest:
Fraser, Pare and Genereaux ................................................................Reference Text
2. The Lung: Radiological and Pathological Correlation:
Heintzman, 2nd Edition ..........................................................................Must Read
3. Chest Radiology:
Felson....................................................................................................Must Read
4. Imaging of Diseases of the Chest:
Armstrong..............................................................................................Must Read
5. High Resolution CT Scanning:
Műller.....................................................................................................Additional Text
C. CARDIOLOGY:
1. Essentials of Cardiac Diagnosis and Imaging:
Higgins, 2nd Edition ...............................................................................Good Reference Text
2. Essentials of Cardiac Roentgenology:
Chen ......................................................................................................Basic Plain Film
50
Interpretation
3. Plain Film Interpretation of Congenital Heart Disease:
Swischuk ...............................................................................................Must Read
4. Cardiac Radiology: The Requisite Series:
Miller ………………………………………………………………………..Reference
D. MAMMOGRAPHY:
Breast Imaging:
Kopans ..................................................................................................Must Read
1. Teaching Atlas of Mammography:
Tabar and Dean ....................................................................................Must Read
E. PEDIATRICS:
1. Practical Pediatric Imaging:
Kirks ......................................................................................................Reference Text
2. Essentials of Caffey’s X-ray Diagnosis:
Silverman and Kuhn..............................................................................Reference Text
3. Imaging of the Newborn, Infant and Child:
Swischuk ...............................................................................................Must Read
4. Emergency Radiology of the Acutely Ill or Injured Child:
Swischuk ...............................................................................................Must Read
F.
GASTROINTESTINAL:
1. Gastrointestinal Radiology:
Gore and Levine ...................................................................................Must Read
2. Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy:
Meyers...................................................................................................Must Read
3. Gastrointestinal Radiology: A Pattern Approach:
Eisenberg ..............................................................................................Additional Text
4. Double Contrast Gastrointestinal Radiology:
Laufer ....................................................................................................Additional Text
5. Computed Tomography of the Body:
Moss, Gamsu, Genant ..........................................................................Reference Text
G. GENITOURINARY:
51
1. Textbook of Uroradiology:
Dunnick, Reed and McCallum (new edition) ........................................Must Read
2. Clinical Urography (1990):
Pollack ...................................................................................................Additional Text
H. SKELETAL:
1. Bone and Joint Imaging (mini version):
Resnick .................................................................................................Must Read
2. Arthritis in Black and White:
Brower ...................................................................................................Must Read
3. Radiology of Bone and Joint Diseases:
Greenfield ..............................................................................................Reference Text
4. Orthopedic Radiology:
Greenspan ............................................................................................Reference Text
5. Radiology of Skeletal Trauma:
Rogers ...................................................................................................Reference Text
I.
NEURORADIOLOGY:
1. Neuroradiology: The Requisite Series:
Grossman..............................................................................................Must Read
2. Diagnostic Neuroradiology:
Osborn...................................................................................................Must Read
3. Computed Tomography of the Head, Neck and Spine:
Latchaw .................................................................................................Reference
4. The Radiology of Acute Cervical Spine Trauma:
Harris .....................................................................................................Must Read
5. Introduction to Cerebral Angiography:
Osborn...................................................................................................Reference Text
6. The Radiology of Acute Cervical Spine Trauma:
Harris .....................................................................................................Must Read
7. MRI: Central Nervous System:
Kucharczyk............................................................................................Reference Text
8. MR of the Brain and Spine:
Scott Atlas ……………………………………………………………………Reference Text
J. EAR, NOSE AND THROAT:
1. Head and Neck Imaging:
52
Som and Bergeron ................................................................................Reference Text
2. Handbook of Head & Neck Imaging
Harnsberger ..........................................................................................Reference Text
K. ANGIOGRAPHY AND INTERVENTIONAL:
1. Diagnostic Angiography:
Kadir ......................................................................................................Must Read
2. Abrams Angiography: Vascular and Interventional Radiology:
Abrams ..................................................................................................Reference Text
3. Gastrointestinal Angiography:
Reuter and Redman..............................................................................Reference Text
L. CT and MRI:
1. Fundamentals of Body CT:
Brant & Helms .......................................................................................Must Read
2. Diagnostic Imaging – Abdomen:
Federle ..................................................................................................Reference Text
3. Abdominal – Pelvic MRI:
Semelka …………………………………………………………………….Reference Text
4. Computed Body CT with MRI Correlation:
Lee, Sagel and Stanley ……………………………………………………Reference Text
5. Magnetic Resonance Imaging:
Stark and Bradley ………………………………………………………….Reference Text
M. ULTRASOUND:
1. Diagnostic Ultrasound:
Rumack, Wilson and Charbonneau......................................................Must Read
2. Ultrasonography in Obstetrics & Gynecology:
Cullen ……………………………………………………………………….Reference
3. Ultrasound – The Requisite Series
Kurtz…………………………………………………………………………Must Read
53
N.
NUCLEAR MEDICINE:
Essentials of Nuclear Medicine Imaging
Mettler and Guiberteau .........................................................................Must Read
1. Diagnosis in Nuclear Medicine
Gottschalk, 2nd edition ...........................................................................Reference
2. Nuclear Medicine – The Requisite Series
Zeissman …………………………………………………………………..Reference
O. PHYSICS:
1. Christensen’s Physics of Diagnostic Radiology:
Curry and Dowdey (4th edition) .............................................................Must Read
2. Introductory Physics of Nuclear Medicine:
Chandra ................................................................................................Reference
P. BIOSTATISTICS:
1. Biostatistics in Clinical Medicine:
Ingelfinger, Mosteller, et al....................................................................Reference
Q. RADIOBIOLOGY:
1. Medical Radiation Biology:
Pizzarello ...............................................................................................Reference
54
SECTION 2
Aims and Objectives:
PGY I RCPSC Specialty Programs
55
Aims & Objectives: PGY I RCPSC Specialty Programs
http://www.med.mun.ca/getdoc/3fd0a6ce-858b-465b-99a5-b9d102145682/Complete-Aims-andObjectives.aspx
INTRODUCTION
A training program must have clear and measurable objectives. These objectives must include both
cognitive and non-cognitive areas and appropriate evaluation is essential. In-training evaluation will be
completed by the designated attending staff in each rotation. The trainee will be responsible for completing
the trainee evaluation of the rotation. The in-training objectives and the trainees' attention to these objectives
become very important as they attempt to achieve the goals we have set. These objectives are intended to
serve as an outline of the essential elements of each rotation. Although not all named conditions may be
seen by every trainee for every rotation, trainees should be familiar with them. In many cases, you may be
able to achieve a much higher level of knowledge than outlined by these minimal objectives.
56
EMERGENCY COMPONENT OF THE PGY I PROGRAM
I.
PROGRAM OBJECTIVES
Through the high volume of attending patients the trainee has the opportunity to acquire history and physical
assessment skills, the ability to develop a differential diagnosis and to formulate investigative and treatment
plans under the guidance and direction of the staff emergency physician. The trainee will learn to manage
time and co-ordinate the care of a number of patients simultaneously. Communication skills should improve
by case discussions with the staff emergency physician and consulting services and speaking to concerned
patients and relatives.
The trainee will be expected to participate in the provision of pre-hospital care and must be prepared to
provide both basic and advanced life support in the pre-hospital environment. Radio and telephone
consultation with the emergency physician on duty is readily available.
Specific Objectives for the Anatomical Pathology PGY I's
Knowledge of the appropriate procedures for certification in cases of sudden death and when to request
medico-legal autopsies is expected.
Specific objectives for (program)
II. MEDICAL EXPERT
Knowledge:
1.
To know the presentation and management of common medical, surgical and traumatic
emergencies.
2.
To recognize the indications/contra-indications and complications of emergency invasive and noninvasive procedures.
3.
To know the indications/non-indications for laboratory, imaging (CAT, MRI, nuclear, traditional) and
cardiologic investigations appropriate to the emergency setting.
4.
To recognize and assess the medico-social, psychological and legal aspects of acts of human
violence.
Skills:
1.
To perform an appropriate initial assessment of the undifferentiated patient.
2.
To rapidly recognize the acutely ill/injured patient and to develop a systematic, prioritized approach
to assessment and concomitant stabilization and treatment.
3.
To quickly formulate a working differential diagnosis, focusing initially on those serious conditions
that need prompt confirmation or exclusion.
4.
To acquire an in-depth expertise in resuscitative medicine, as well as a broad exposure to this
generalist's specialty.
5.
To acquire skills in emergency invasive and non-invasive procedures.
57
COMMUNICATOR
1.
To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2.
To demonstrate the ability to take an effectively focused history.
3.
To demonstrate the ability to deliver/receive information to/from patients and families
4.
To demonstrate the ability to deliver information to colleagues and members of the health care team.
COLLABORATOR
1.
To know and respect the appropriate roles and skills of members of the health care team.
2.
To demonstrate the ability to work effectively within the health care team.
3.
To contribute effectively to interdisciplinary team activities.
HEALTH ADVOCATE
1.
To identify important determinants of health as it affects a particular patient.
2.
To recognize and describe important health determinants for the population utilizing emergency
services.
3.
To promptly formulate and establish assessment/therapeutic endpoints with appropriate
referral/disposition.
MANAGER
1.
To develop the ability to manage several patients simultaneously.
2.
To develop triage skills appropriate to the management of as yet undifferentiated patients, and to
develop the ability to prioritize the care to be administered to such patients.
3.
To utilize investigative/laboratory resources efficiently.
PROFESSIONAL
1.
To develop good habits of charting, with concise recording of pertinent negative and positive
findings.
2.
To exhibit appropriate personal and interpersonal professional behaviours.
3.
To develop a greater appreciation of issues of consent, minors and adults, confidentiality and the
roles of outside agencies (police, media, social services, public health) in the emergency setting.
4.
To demonstrate an understanding of and compliance with mandatory reporting laws.
58
SCHOLAR
1.
To demonstrate an ability to recognize learning needs.
2.
To critically appraise sources of medical information.
3.
To actively participate in learning opportunities.
4.
To facilitate learning of patients, other housestaff/students and other health professionals.
III. METHOD OF EVALUATION
1.
The method of evaluation will come from the clinical case presentations and discussions with the
Staff Emergency Physician on a day-to-day basis.
2.
Charting - Charts are audited daily and evaluated by the staff emergency physicians.
3.
Quality of care rendered to the patients.
4.
Nurses'/other Health Professionals’ critique - Because of the interaction of allied professionals with
the trainee and their vast experience, they often have very valuable impressions of the trainees.
5.
Patient's input - We often have comments from the patients or their relatives regarding treatment and
attitudes or behaviour of the housestaff.
IV. ORIENTATION
Before starting in the Emergency Department, housestaff must receive orientation from a staff emergency
physician. An orientation meeting takes place in the Emergency Department at 0800 hours on the day that
each rotation commences. The intent of these orientations is to familiarize the housestaff with the structure
and function of the Emergency Department as well as the ambulance service. It is during this session that
the trainees are given the opportunity of having hands-on experience with the Life-Pak 5 (monitor
defibrillator), MAST Trousers, as well as the slit lamp, etc.
59
INTERNAL MEDICINE COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
Undergraduate teaching and training do not, by themselves, prepare the student adequately for independent
medical practice. There is a need to continue the teaching and training in internal medicine from the
clerkship program into the PGY I program. During the PGY I year, clinical experience should be offered on a
broader and more advanced level than the one gained during clerkship.
II. PROGRAM OBJECTIVES
The overall objective of training and teaching is to equip the trainee with the knowledge, skills and attitudes
of internal medicine that would be of help to the non-internist. The program will aim to achieve the following:
1.
To expand and consolidate the knowledge and clinical skills and abilities gained during clinical
clerkship.
2.
To provide clinical experience in:
i.
ii.
iii.
3.
ambulatory care,
emergency care,
in-hospital and continuing care.
To provide trainees with sufficient knowledge and skills to be confident in the detection and
management, at a primary care level, of the most frequent forms of illness encountered in internal
medicine. They should also provide the knowledge that would enable appropriate specialist
consultation.
Specific Objectives for the Anatomical Pathology PGY I's
1.
Attendance at autopsies of patients from the service is expected.
2.
The clinical significance of both histopathology and other laboratory reports should be emphasized.
III. MEDICAL EXPERT
Knowledge:
1.
To demonstrate knowledge of the common symptom complexes, acute illnesses and medical
emergencies as they present in various settings (ambulatory care setting, hospital). Including but not
limited to:
i. myocardial infarction
ii. angina
iii. congestive heart failure
iv. bronchial asthma, exacerbation of chronic obstructive lung disease
v. cardiac arrhythmias and cardiac arrest
vi. cerebrovascular accidents
vii. drug overdose and poisoning
viii. DVT/pulmonary embolism
ix. gastro-intestinal bleeding/peptic ulcer disease
x. diabetes/hypoglycemia
60
xi. hypertension
xii. common infections such as pneumonia, cystitis and pyonephritis
xiii. altered level of consciousness
xiv. acid base, fluid and electrolyte balance
xv. anemias
xvi. jaundice
xvii. obesity
xviii. seizure disorders
xix. degenerative and rheumatoid arthritis
xx. Parkinson's disease
xxi. tuberculosis
xxii. bleeding disorders
xxiii. sexually transmitted diseases
xxiv. myxedema and thyrotoxicosis
xxv. peripheral vascular disease
xxvi. gout
xxvii. dementia
xxviii. acute and chronic renal failure
xxix. aging and its influence on presentation, diagnosis and management
xxx. headache
xxxi. common peripheral nerve disorders
2.
To demonstrate the ability to recognize the principles of management and recognition of other
medical problems including various leukemias, lymphoma, multiple myeloma, AIDS and various
carcinomas.
3.
To demonstrate knowledge of the indications/contraindications for laboratory, imaging and other
investigations.
4.
To demonstrate knowledge of the side effects of treatment including drug toxicities.
5.
To demonstrate knowledge of the resuscitation and management of the critically ill patient.
Skills:
1.
To perform an appropriate history and physical examination, recognizing significant positive and
negative physical signs.
2.
To formulate a differential diagnosis and a treatment plan.
3.
To perform the following
i. insertion and management of intravenous lines.
ii. an arterial blood gas.
iii. an electrocardiogram.
iv. bladder catheterization.
v. a bone marrow aspiration and biopsy.
4.
To demonstrate an understanding of the principles of management medical problems including
various leukemias, lymphoma, multiple myeloma, AIDS and various carcinomas.
61
COMMUNICATOR
1.
To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2.
To demonstrate the ability to perform an effectively focused history.
3.
To demonstrate the ability to effectively deliver/receive information back to/from patients and
families.
4.
To demonstrate the ability to effectively deliver/receive information to/from colleagues and members
of the health care team.
5.
To complete written documentation clearly and effectively in a timely manner.
COLLABORATOR
1.
To know and respect the appropriate roles and skills of member of the health care team.
2.
To demonstrate the ability to work effectively within the health care team.
3.
To be conscious of the needs of others including fellow staff members and patients.
4.
To contribute effectively to interdisciplinary team activities.
HEALTH ADVOCATE
1.
To demonstrate knowledge of home and community support services for the chronically ill.
2.
To identify important determinants of health as they affect particular patients.
3.
To promptly formulate and establish assessment/therapeutic endpoints.
MANAGER
1.
To understand the impact of the cost of treatment.
2.
To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3.
To be attentive to preventative measures.
PROFESSIONAL
1.
To recognize and deal with one's own anxieties, limitations and personal prejudices.
2.
To demonstrate a sense of responsibility.
3.
To demonstrate accurate self-assessment skills (e.g. insight).
SCHOLAR
1.
To demonstrate an ability to recognize learning needs.
2.
To critically appraise sources of medical information.
3.
To actively participate in learning opportunities.
4.
To facilitate learning of patients, other housestaff/students and other health professionals.
62
IV. CLINICAL TEACHING UNIT EXPERIENCE
The Health Sciences Centre and St. Clare's Mercy Hospital provide general medicine and subspecialty
clinical teaching experience.
In the General Hospital, Health Sciences Centre, there are four general medical services and two
subspecialty services, cardiology and neurology. Each general medical service is comprised most often of
attending physicians, one resident, one PGY I trainee and one clerk. Residents undergoing specialty
experience, elective trainees and elective clerks may also be attached to the units. All units except
cardiology and neurology admit general medical patients from Emergency and as electives on a rotating
basis. However, each unit also has certain subspecialty interests. The attending physicians on Clinical
Training Unit I are nephrologists.
The attending physicians on CTU II include endocrinologists, infectious disease specialist, a general
internist. The attending physicians on CTU III include hematologists, a general internist and oncologists. The
attending physicians on CTU IV include gastroenterologists and respirologists. Most of these physicians also
practice internal medicine.
At St. Clare's Mercy Hospital, there are four general medical units. Again these units include attending
physicians who are general internists and subspecialists. A subspecialty clinical unit in rheumatology is also
available for elective rotations.
Ambulatory care is a compulsory part of each rotation at the Health Sciences Centre. This experience is also
available through some clinics at St. Clare's Mercy Hospital.
Each affiliated hospital provides weekly teaching conferences. At the Health Sciences Centre there are
subspecialty rounds three times per week, weekly medical grand rounds and semi-monthly medical
pathology conferences. A basic science lecture series is integrated into the round format. St. Clare's Mercy
Hospital provides medical grand rounds, clinical pathological conferences and a weekly teaching session, as
well as a subspecialty round in rheumatology.
The trainee is expected to be involved in the presentation of his/her patients' case histories at the various
formal rounds.
III. ORIENTATION
PGY I trainees receive an orientation as a group at the beginning of the year and as each trainee joins a
clinical teaching unit a further orientation is provided by PGY coordinator or administrative resident(s) in
internal medicine, the resident and/or attending staff provide individual orientation to the service and to the
hospital as is appropriate. A written orientation that includes responsibilities within the medical care team of
the unit is provided to the trainee at the beginning of a rotation.
On each clinical teaching unit the trainee is responsible for the clinical evaluation of new admissions
(emergency or elective) assigned by the resident or attending physician and, from this information, to
analyze the medical and psycho-social problems in order to develop an appropriate investigational and
therapeutic approach. The trainee is also responsible for the continuing care of any patient assigned to
him/her. These activities take place under the supervision of the medical resident and/or attending
physician. Trainees are responsible for undertaking medical investigational procedures on their patients
under the supervision and at the discretion of the resident and/or attending physician. The trainee should
assess as many emergency patients' admissions in the Emergency Room as possible.
63
IV. EVALUATION
This is an ongoing process during the rotation. The trainee is provided with verbal feedback during the
rotation by the resident and attending physician through case review and service teaching rounds. At the
end of each four-week period, the trainee is provided with an in-training evaluation report from the attending
physicians and residents on the clinical teaching unit. Since the trainee is required to sign this evaluation, an
opportunity is provided for feedback at that time.
Because the period of training on any clinical teaching unit is so short, an attempt is made to quickly identify
trainees with specific problems in order that these may be rectified. It is also hoped that, if any trainee
recognizes that he or she faces problems that in any way jeopardize the learning experience provided on a
specific clinical teaching unit, these problems will be brought to the immediate attention of the PGY I coordinator so that appropriate action may be taken.
64
OBSTETRICS & GYNECOLOGY COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
The PGY I trainee will spend two months on a combined obstetrics and gynecology rotation. The rotation
has been designed to provide a learning experience as well as a portion of service commitment to the
trainee. The trainee is assigned to a team consisting of several attending staff physicians, a resident, a PGY
I trainee and a clinical clerk. The team provides experience and responsibility in patient care in ambulatory
clinics, inpatient obstetrics and gynecology, operating room and labour/delivery.
II. PROGRAM OBJECTIVES
1.
To develop awareness and insight into general obstetrical and gynecological problems encountered,
thus developing professional responsibility and expertise to assume the responsibilities of obstetric
and gynecological care in general practice.
2.
To provide the trainee with the necessary insight and skill to recognize abnormalities and his/her
limitations in dealing with these abnormalities and the knowledge to decide when a referral for a
specialist consultation is in the patient's best interest.
3.
To develop specific skills in the area of obstetrics and gynecology and to be able to undertake
antenatal, intrapartum and postpartum care.
4.
To develop awareness of the special relation and ethical responsibilities which exist between a
physician and patient in obstetrics and gynecology, with specific regard to birth control and the
changing role of women in modern society.
Specific Objectives for Obstetrics and Gynecology PGY1s
In Addition to all those listed below it is expected at the end of the rotation you will be able
1.
To conduct a normal delivery and repair an uncomplicated episiotomy or tear and manage the third
stage of labour.
2.
To assess the progress of labour and recognize deviations from normal.
2.
To demonstrate an understanding of the indications for use of fetal monitors and recognize basic
abnormal patterns.
3.
To demonstrate a current knowledge of indications for and side effects of analgesics and anesthetics
in labour and delivery.
Specific Objectives for the Anatomical Pathology PGY I's
1.
Attendance at autopsies of stillbirths/late abortions which occur in the service is expected.
2.
Follow-up of specimens taken in the Colposcopy Clinic with review of the histological/cytological
specimens is expected.
65
Specific Objectives for Psychiatry PGY I’s
1.
Familiarity with the teratogenic potential of the various psychotropic medications is expected.
2.
Recognize risk factors for postpartum depression and grieving from infertility and miscarriage.
Specific Objectives for Anesthesia PGY I’s
1.
To demonstrate a current knowledge of indications for and side effects of analgesics or anesthetics
in labour and delivery.
III. MEDICAL EXPERT
Knowledge:
Obstetrics
1.
To demonstrate knowledge of the normal progress of pregnancy, specifically antenatal testing (MSS,
amnio etc.) and delivery and the common abnormalities found in a general practice.
2.
To understand the normal course of labour.
3.
To demonstrate knowledge of the effects of common medical problems on pregnancy and delivery,
and recognize when pre-conceptual counseling for a pre-existing medical problem is warranted.
4.
To be aware of the special needs of both the mother and the infant during labour and the immediate
postpartum period - including potentially life threatening conditions i.e. postpartum hemorrhage,
gestational hypertension and venous thromboembolic disease.
Gynecology
1.
To demonstrate an understanding of common gynecological conditions and of the appropriate
treatments.
2.
To recognize the less common gynecological conditions and to know the indications for referral to a
specialist i.e pelvic inflammatory disease, abnormal Pap smear, pelvic pain and ovarian cysts.
3.
To demonstrate knowledge of infertility investigation.
Skills:
Obstetrics
1.
To undertake to provide good prenatal care and assessment for patients.
2.
To demonstrate the ability to recognize abnormalities and assess risk factors that arises anytime in
the prenatal period.
3.
To demonstrate the ability to recognize the indications for a referral or consultation at the earliest
possible time.
4.
To conduct a normal labour and vaginal delivery including third stage.
5.
To assess progress of labour and recognize deviations from normal at the earliest possible time.
66
6.
To perform episiotomy and repair, if indicated.
7.
To act effectively in the case of hemorrhage.
8.
To manage routine postpartum care.
9.
To perform an adequate post partum examination.
10.
To recognize the particular emotional needs of the mother and family in the postnatal and
subsequent period.
11.
To advise on subsequent family planning.
Gynecology
1.
To perform an adequate pelvic examination, including Pap smear and cultures
2.
To initiate appropriate infertility investigations.
COMMUNICATOR
1.
To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2.
To demonstrate the ability to perform an effectively focused history.
3.
To demonstrate the ability to effectively deliver information back to patients and families.
4.
To demonstrate the ability to deliver information to colleagues and members of the health care team.
5.
To demonstrate skills in reproductive and fertility counseling including:
i.
ii.
iii.
iv.
6.
counseling patients with specific medical problems with regard to their outcome in pregnancy
and optimizing their status prior to conception.
Counseling a pregnant patient in matters of family involvement, nutrition activity and
medication throughout the pregnancy.
Counseling for sterilization.
Counseling with regard to continuation or termination of pregnancy.
To complete written documentation clearly and effectively in a timely manner.
COLLABORATOR
1.
To know and respect the appropriate roles and skills of members of the health care team.
2.
To demonstrate the ability to work effectively within the health care team.
3.
To be conscious of the needs of others including fellow staff members and patients.
4.
To contribute effectively to interdisciplinary team activities.
HEALTH ADVOCATE
1.
To obtain consultation in an appropriate and timely way.
67
2.
To understand the health advantages of and advise on infant nutrition - breastfeeding or other
methods.
3.
To identify important determinants of health as they affect particular patients.
4.
To promptly formulate and establish assessment/therapeutic endpoints.
MANAGER
1.
To understand the impact of the cost of treatment.
2.
To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3.
To be attentive to preventative measures.
PROFESSIONAL
1.
To recognize and deal with one's own anxieties, limitations and personal prejudices.
2.
To demonstrate a sense of responsibility.
3.
To demonstrate accurate self-assessment skills (e.g. insight).
SCHOLAR
1.
To demonstrate an ability to recognize learning needs.
2.
To critically appraise sources of medical information.
3.
To actively participate in learning opportunities.
4.
To facilitate learning of patients, other house staff/students and others.
IV. SERVICE OBJECTIVES
Attempts are made to ensure equitable division of labour with regard to the service commitment. It must be
recognized, however, that the majority of teaching is through the experience gained in management of
patients and in bedside discussions, and thus the service component is an integral part of learning in
obstetrics and gynecology. Indeed, obstetrics and gynecology being essentially practical subjects, it is not
possible to over-emphasize the importance of the service element of this rotation in terms of learning.
However, it is hoped that the service commitment will be undertaken in the overall perspective of team work.
PLAN FOR ACHIEVING EDUCATIONAL OBJECTIVES
Patient Management - The trainee will be a member of a team comprised of a staff member, resident and
clinical clerk who are responsible for the day-to-day management of the patients on the service. In order to
gain experience, it will be necessary to take part in the management plan of the patients and to execute the
plan devised by the team as far as possible and to make use of bedside teaching and work rounds. Because
of the nature of the specialty, ward rounds cannot be carried out at the same time on a daily basis.
Practical Obstetrics and Gynecology - It is important that the trainee expand his/her experience beyond
the routine workload and to this end he/she should be aware, as far as possible, of practical problems and
associated medical conditions which are being managed within the unit, although these may not be on the
68
team to which he/she is assigned. Trainees will be expected to familiarize themselves with any unusual
cases on the service in order to augment their experience. They will be expected to participate in the care of
patients antenatally and postpartum. Intrapartum care of patients is dependent on specialty and we
encourage trainees to participate however it is not mandatory to perform an obligate number of deliveries.
We do expect trainees to be familiar with the progress of labour and delivery, that in event of an emergent or
precipitous vaginal delivery they could safely perform it. They should also become aware of fetal monitoring
techniques, and be able to determine abnormal versus normal fetal tracing, as pertains to transport of a
patient form the periphery or for the antenatal floor, especially in the high-risk patient, both prior to and
during labour. Pelvic examinations are to be carried out with the guidance of the resident on duty or the staff
person; this applies particularly in the case room. In the case of gynecology patients, pelvic examinations
are done, where practical, following the admission history and physical under the guidance of the resident.
Trainees are encouraged to come to the operating room, with the guidance of the staff person, where more
adequate pelvic examinations may be carried out, under general anesthetic. Trainees are expected to be
present in the OR for all cases they have admitted or which are on their service.
Outpatient Experience - Outpatient clinics in obstetrics and gynecology are held five days a week at the
Women’s Health Centre. The trainee is expected to attend these outpatient clinics to obtain further
knowledge and experience in the management of antenatal, postnatal and gynecological outpatients such
as one would find in general practice. He/she is also expected to attend calls to the Emergency Department
with the resident and participate in the diagnosis and management of these cases, which may be treated on
an outpatient basis or admitted to the hospital as the situation warrants.
Didactic Teaching - At the Women’s Health Centre, there are grand rounds and high risk rounds each
week, and the trainee is expected to attend these sessions. There are also weekly rounds in neonatology,
pathology and radiology which are oriented to the trainees on the obstetrical and gynecological service.
EVALUATION
Trainees will be evaluated using the standard ITER forms. The evaluation is a team effort which is
performed at the regular meeting of the medical staff in the Department of Obstetrics and Gynecology.
OBSTETRICS & GYNECOLOGY – Women’s Health Centre, Janeway Site
The staff obstetricians and gynecologists in this division are:
Dr. E. Bartellas
Dr. J. Dunne
Drs. C. Popadiuk/L. Dawson/P. Power (Gyn Oncology)
Drs. T. Delaney/J. Crane (MFM)
Drs. A. Gill/T. Strand (Urogynecology)
Dr. E. Howse
Dr. H. Kravitz
Dr. F.N. Kum
Drs. T. O’Grady/S. Healey (Reproductive Endocrinology)
Dr. C. Pike
Dr. P. Roche
Dr. D. A. Tennent
V. SUMMARY
The obstetrical and gynecological program for PGY I trainees is reviewed. The objectives of their program
are defined. It is hoped that the trainees will take advantage of the wealth of material available both on the
inpatient service and in the outpatient clinics and Emergency Department, to gain experience and develop
expertise in the normal physiology and endocrinology of obstetrics and gynecology and become
experienced in the management of these problems, as well as the problems of reproduction control and the
development of the particular insight required to practice in this discipline.
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PEDIATRIC COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
The PGY I trainee's experience in pediatrics will include instruction in the assessment and care of
hospitalized patients from birth through adolescence and the assessment and management of ambulatory
patients of the same age.
II. PROGRAM OBJECTIVES
The overall objective is to enable you to acquire the ability to assess and assist the well and the sick child as
an individual and within the family, to understand the responses of the child and family to these situations
and to efficiently and appropriately access the resources available. Please note it is the responsibility of the
trainee to ensure completion of the ITER by the appropriate Pediatrician and the prompt return of the ITER
and completed program evaluation form to the Postgraduate Medical Studies Office.
Specific Objectives for the Anatomical Pathology PGY I's
Attendance at any pediatric autopsies which occur during this rotation is expected.
III. MEDICAL EXPERT
Knowledge:
1.
To demonstrate knowledge of signs and symptoms related to common pediatric disorders, including
emergencies, developmental, psychiatric and behavioural disorders.
2.
To demonstrate recognition of less common pediatric disorders.
3.
To demonstrate knowledge of treatment and management of common pediatric disorders.
4.
To demonstrate knowledge of normal development and recognition of abnormal development.
5.
To demonstrate and understanding of the indications and contraindications of investigation and
procedures.
Skills:
1.
To demonstrate the ability to complete a focused history and physical examination.
2.
To formulate and carry out an effective treatment plan for common pediatric disorders.
3.
To demonstrate resuscitative skills.
4.
To demonstrate effective use of investigations.
COMMUNICATOR
1.
To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2.
To demonstrate the ability to perform an effectively focused history.
3.
To demonstrate the ability to effectively deliver information back to patients and families.
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4.
To demonstrate the ability to deliver information to colleagues and members of the health care team.
5.
To complete written documentation clearly and effectively in a timely manner.
COLLABORATOR
1.
To know and respect the appropriate roles and skills of members of the health care team.
2.
To demonstrate the ability to work effectively within the health care team. 3. To be conscious of the
needs of others including fellow staff members and patients. 4. To contribute effectively to
interdisciplinary team activities.
HEALTH ADVOCATE
1.
To identify important determinants of health as they affect particular patients.
2.
To promptly formulate and establish assessment/therapeutic endpoints.
3.
To appreciate the impact of acute or chronic illness on child and family and provide empathetically
the appropriate information and support.
MANAGER
1.
To understand the impact of the cost of treatment and judiciously use available resources.
2.
To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3.
To be attentive to preventative measures.
PROFESSIONAL
1.
To be recognize and deal with one's own anxieties, limitations and personal prejudices.
2.
To demonstrate a sense of responsibility.
3.
To demonstrate accurate self-assessment skills (e.g. insight).
4.
To understand and apply ethical principles to clinical work.
SCHOLAR
1.
To demonstrate an ability to recognize learning needs.
2.
To critically appraise sources of medical information.
3.
To actively participate in learning opportunities.
4.
To facilitate learning of patients, other house staff/students and others.
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IV. RESOURCES AVAILABLE TO ASSIST THE PGY I TRAINEE IN ACHIEVING OBJECTIVES
FACILITIES
Facilities include wards, laboratories and ambulatory service at the Janeway Children’s Health and
Rehabilitation Centre for a total of 110 medical and surgical beds, which approximately half are medical, but
this varies from time to time according to need.
In addition to this, the Emergency and Out-Patient Departments have approximately 65,000 visits during the
year. Of this, about 35,000 are seen in the Emergency Department (where a period of time is spent by the
PGY I trainee) and 30,000 are seen in clinics that include ENT, Orthopedics, Developmental, Neurology,
Nephrology, etc.
IV. ORIENTATION
Trainees receive an orientation as a group at the beginning of the year. Then as each trainee joins the
Janeway Children’s Health and Rehabilitation Centre, the discipline coordinator or the physician in charge of
the ambulatory service will provide orientation to the service and to the hospital as appropriate.
V. METHODS OF EVALUATION
Evaluation is an ongoing process during the rotation. The trainee is provided with verbal feedback during the
rotation by the resident and attending physician through case review and session teaching rounds. At the
end of each four week period the trainee will meet with the attending pediatrician and will be provided with
an ITER. This interview at the end of the rotation will provide a forum for mutual feedback.
Evaluation is based on the quality of work done together with attitude factors, which include
conscientiousness, dependability, acceptance of responsibility for patient care, avoidance of careless errors,
sensitivity to patients' feelings and willingness to receive constructive criticism.
The trainee is asked to discuss and submit an evaluation of his/her experience within the hospital, indicating
areas in which he/she feels there are deficiencies or in which the experience appears to be exceptionally
useful.
The discipline coordinator and/or team leader and/or assigned pediatrician to the trainee will welcome any
trainee who wishes to approach them regarding any concerns that needs to be addressed during the
rotation.
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PSYCHIATRY COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
It has been our view that the undergraduate teaching and training do not, by themselves, prepare the
student adequately for independent medical practice, and there is a need to continue the teaching and
training in clinical psychiatry from the clerkship program into the PGY I program. During the PGY I program,
clinical experience should be offered on a broader and more advanced level than the one gained during the
clerkship.
II. PROGRAM OBJECTIVES
The overall objective of the training and teaching is to equip the trainee with skills, attitudes and knowledge
of clinical psychiatry which are of help to non-psychiatric physicians. These include the ability to co-operate
effectively with the psychiatrist and other mental health workers in the care of patients who have psychiatric
disorders and who live in the community. The program will specifically aim to achieve the following:
1.
To expand and consolidate the knowledge, clinical skills and abilities gained during the clinical
clerkship.
2.
To provide clinical experience:
a. consultation-liaison psychiatry,
b. ambulatory care,
c. community care,
d. crisis management and emergency psychiatry, and
e. inpatient psychiatry care.
3.
To increase the trainee's knowledge of and ability to deal appropriately with the intimate relationship
between emotional and physical illness.
4.
To provide the trainee with sufficient knowledge and skills to be competent in the detection and
management at a primary care level of the most frequent forms of mental disorder, including a
knowledge of:
a. available and appropriate community adjuncts to treatment, and
b. appropriate indications for specialist consultation.
III. MEDICAL EXPERT
Knowledge:
1.
To demonstrate knowledge of the signs and symptoms of major mental disorders, in particular,
disorders of emotion, thinking and cognition.
2.
To demonstrate understanding of the potential etiological determinants of major mental disorders,
including their possible interactions.
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3.
To demonstrate appreciation for the psychological, familial and social factors that can influence the
presentation and management of both mental and physical illnesses.
4.
To demonstrate knowledge of the indications for and the risks and benefits of psychiatric care,
specifically:
i) forms of psychotherapy,
ii) physical treatment, including the use of anxiolytics, antidepressants, ECT, and antipsychotics,
iii) formal and informal community support systems, and
iv) transfer, restraint, and civil commitment procedures.
Skills:
1.
To demonstrate the ability carry out a comprehensive psychiatric assessment, specifically including
an evaluation of a patient's mental state, physical status and familial/social circumstances.
2.
To detect significant mental disorders as well as mental influences upon a person's state of physical
health.
3.
To accurately identify emergency and crisis situations and to carry out crisis intervention.
4.
To implement an appropriate treatment plan, taking into account:
i)
ii)
iii)
the diagnosis,
the urgency of the situation, and
the available family, social and health care resources most appropriate to the situation,
including indications for admission.
COMMUNICATOR
1.
To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2.
To demonstrate the ability to perform an effectively focused history.
3.
To demonstrate the ability to effectively deliver information back to patients and families.
4.
To demonstrate the ability to deliver information to colleagues and members of the health care team.
5.
To complete written documentation clearly and effectively in a timely manner.
COLLABORATOR
1.
To know and respect the appropriate roles and skills of members of the health care team.
2.
To demonstrate the ability to work effectively within the health care team.
3.
To be conscious of the needs of others including fellow staff members and patients.
4.
To contribute effectively to interdisciplinary team activities.
HEALTH ADVOCATE
1.
To know the distribution and impact of mental disorder in the population.
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2.
To identify important determinants of health as they affect particular patients.
3.
To promptly formulate and establish assessment/therapeutic endpoints.
MANAGER
1.
To understand the impact of the cost of treatment.
2.
To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3.
To be attentive to preventative measures.
PROFESSIONAL
1.
To be recognize and deal with one's own anxieties, limitations and personal prejudices.
2.
To demonstrate a sense of responsibility.
3.
To demonstrate accurate self-assessment skills (e.g. insight).
4.
To understand and apply ethical principles to clinical care.
SCHOLAR
1.
To demonstrate an ability to recognize learning needs.
2.
To critically appraise sources of medical information.
3.
To actively participate in learning opportunities.
4.
To facilitate learning of patients, other house staff/students and others.
IV. PROCEDURE
The rotation through psychiatry will extend over a four-week period. Each trainee will spend the entire four
weeks in one of the following settings:
1.
2.
in the Department of Psychiatry at the Health Sciences Centre, or
at the Waterford Hospital.
The allocation, while taking the preferences of the trainee into account, will be made by the PGY I cocoordinator to prevent overloading of any particular setting and secure a rotation profitable to the trainee.
(Trainees wanting to undertake an elective program must satisfy the PGY I co-coordinator that they have an
adequate knowledge of general psychiatry).
V. HEALTH SCIENCES CENTRE
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The services in the different hospitals vary. The trainee will be briefed about his/her program on joining the
unit in question. However, common to all rotations will be:
1.
An ambulatory care component, e.g., day care, out-patient, community care.
2.
Seeing patients on referral in the Emergency Department and collaborating in their management with
the responsible staff and consultants.
3.
Seeing patients referred from non-psychiatric services of the hospital.
4.
Participation in grand rounds and other formal teaching activities of the unit and the university.
5.
Involvement in the various activities of the service on which the trainee is working, e.g., group
meetings, therapeutic community programs.
VI. WATERFORD HOSPITAL
The Waterford Hospital is the main psychiatric hospital in the province; it has several programs in place.
1.
Acute service.
2.
Ambulatory care service, including addictions, community care and day care.
In order to spend these four weeks profitably, a trainee will be attached to Acute Service under the guidance
of the director of training or one of the staff psychiatrists. Learning the distinction between minor and major
psychiatric disorders will be a major focus on this program. As far as formal case presentations or
conferences are concerned, the trainee would attend Grand Rounds every other week and in the intervening
period a local case presentation would be required. Arrangements could also be activated for one or two
seminars with social workers and psychologists if the trainee felt this would be an appropriate learning
experience.
VII. ELECTIVES
Following the satisfactory completion of a general psychiatry rotation, the trainee may undertake a
specialized psychiatric rotation. Trainees shall not normally be permitted to do psychiatry electives of less
than four weeks duration unless those electives are continuous with and in the same hospital setting as their
psychiatry rotation. For specialized rotations, the trainee shall obtain the prior approval of the staff person
involved, the PGY I co-coordinator for psychiatry and the office of Postgraduate Medical Studies.
GERIATRIC PSYCHIATRY
This service, based at the Miller Centre, consists of a day hospital, consultation-liaison service and
community psychiatry program for the elderly. The trainee will participate in all three programs.
Objectives
1.
Exposure to and understanding of psychiatry illness in late life, including assessment, management
and service co-ordination.
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2.
Ability to carry out functional assessments.
3.
Knowledge of support services and agency co-ordination.
FORENSIC PSYCHIATRY
The Waterford Hospital has an inpatient forensic unit. The trainee will get experience in the assessment of
court referrals and in the preparation of court reports. Management of forensic patients will also be part of
this experience.
CHILD PSYCHIATRY (4 weeks)
Electives are available in child psychiatry. The rotation is based in the Psychiatry Department of the
Janeway Children’s Health and Rehabilitation Centre. The department provides psychiatric services for
children and young adolescents for the entire province. About 500 new patients are seen and 100 inpatients
are admitted annually.
The trainee will be exposed to all aspects of diagnostic assessment, decision making and management in
child psychiatry. The PGY I experience will emphasize the following areas:
Outpatient Diagnostic Assessment: The trainee will assess at least two families a week under
supervision, following orientation to the procedure. The trainee will become familiar with the role of a social
worker and in using the expertise of the psychologist in diagnostic assessment. The trainee will learn to
conduct sensitive family interviews and to interview children to elicit relevant information. Home visits and
school visits will be included whenever possible.
Consultation-Liaison: Opportunities to assess children on medical and surgical services referred for
psychiatric opinion. This enables doctors to appreciate the enormous contribution of psychological factors in
children's somatic symptomatology as well as the psychological problems secondary to chronic physical
disease.
Inpatient Service: The trainee will have the opportunity to assess children on an inpatient basis under the
supervision of a staff psychiatrist. Trainees will take part in the night call rotation under the supervision of a
staff psychiatrist.
VIII. EVALUATIONS
Trainees will be evaluated on their knowledge base, clinical skills, attitudes and any other factors deemed
appropriate.
77
SURGERY COMPONENT OF PGY I PROGRAM
PGY I TRAINEE COVERAGE - SURGERY
Trainees at the Health Sciences Centre are assigned to general surgery, neurosurgery, urology or
orthopedics. Orthopedics and neurosurgery have their own separate call schedules distinct from general
surgery and the other subspecialties.
The trainees assigned to general surgery do call on a 1-in-4 rotation with other residents. When on call, this
team covers only general and plastic surgery. The trainee or resident is on first call to the emergency room
and is always backed up by the chief resident in general surgery, who does not do in-hospital calls. The staff
surgeon is always available.
The trainees assigned to neurosurgery do call on a 1-in-3 to 1-in-4 rotation. When on call, members of this
team would cover only neurosurgery, including calls to the emergency room.
I. PROGRAM OBJECTIVES
1.
To encourage development of professional responsibility by providing definite service duties that will,
in addition, provide benefit to the patients and allow for a wide range of case study material for the
trainee.
2.
To develop specific skills in surgical management so that the trainee will be better able to fulfill their
role as a physician.
Specific Objectives for the Anatomical Pathology PGY I's
1.
Know the procedures for submitting surgical specimens to the laboratory and the special
requirements for specimens such as lymph nodes, breast biopsies, lungs and muscle biopsies.
2.
Attendance at autopsies of patients from the service is expected.
3.
Attendance at frozen sections whilst the PGY I is on O.R. duty is expected.
II. MEDICAL EXPERT
Knowledge:
1.
To recognize common problems that require surgical treatment.
2.
To demonstrate knowledge of common surgical procedures, including indications for and effects of
surgical intervention.
3.
To recognize those situations where surgical intervention is urgent.
4.
To demonstrate knowledge of the routine preoperative management of the surgical patient.
78
5.
To demonstrate understanding of common medical problems that constitute added risk - diabetes,
COPD, medications CHF, IHD, etc.
6.
To demonstrate knowledge of routine postoperative management of surgical patients.
7.
To recognize and know the management of common complications of surgery - deep venous
thrombosis, pulmonary embolism, atelectasis, pneumonia, wound infection, etc.
8.
To demonstrate knowledge of those special diagnostic investigations and techniques used, for which
a patient may require instruction or preparation for the procedure, e.g. IVP, GI series, ultrasound,
angiography, CT scan, gastroscopy, sigmoidoscopy, bronchoscopy, etc.
Skills:
1.
To demonstrate the ability to assess priorities accurately in cases of major trauma and take
appropriate action within the limitation of available facilities and assistance.
2.
To manage the resuscitation of major trauma victims, particularly those with injury to the head, spine,
chest and abdomen.
3.
To demonstrate the ability to clear and maintain an airway and to intubate.
4.
To demonstrate skill in fluid replacement.
5.
To demonstrate the ability to insert tubes into thoracic or peritoneal cavities, if indicated, and be
aware of the technique of diagnostic peritoneal lavage.
6.
To demonstrate the ability splint and immobilize limbs or fractures properly, prior to transportation.
7.
To demonstrate skill in the removal of a skin and superficial lesion, repair of superficial wounds, I and
D of subcutaneous abscesses, etc.
COMMUNICATOR
1.
To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2.
To demonstrate the ability to perform a focused history.
3.
To demonstrate the ability to effectively deliver information back to patients and families.
4.
To demonstrate the ability to deliver information to colleagues and members of the health care team.
5.
To complete written documentation clearly and effectively in a timely manner.
COLLABORATOR
1.
To know and respect the appropriate roles and skills of members of the health care team.
2.
To demonstrate the ability to work effectively within the health care team.
3.
To be conscious of the needs of others including fellow staff members and patients.
4.
To contribute effectively to interdisciplinary team activities.
5.
To manage long-term surgical conditions on an ambulatory basis.
79
HEALTH ADVOCATE
1.
To understand the indication/process for referring patients to consultants and other health care
personnel in caring for surgical problems.
2.
To identify important determinants of health as they affect particular patients.
3.
To promptly formulate and establish assessment/therapeutic endpoints.
4.
To know and utilize lay organizations designed to assist patients with special problems, e.g.,
carcinoma of the breast, ostomies, etc.
5.
Have a knowledge of home care and public health nursing organizations.
MANAGER
1.
To be aware of the cost of various diagnostic and treatment modalities.
2.
To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3.
To be able to work as part of a health care team.
4.
To further develop time management skills.
PROFESSIONAL
1.
To recognize and deal with one's own anxieties, limitations and personal prejudices.
2.
To demonstrate a sense of responsibility.
3.
To demonstrate accurate self-assessment skills (e.g. insight).
4.
To understand and apply ethical principles to clinical care.
SCHOLAR
1.
To demonstrate an ability to recognize learning needs.
2.
To critically appraise sources of medical information.
3.
To actively participate in learning opportunities.
4.
To facilitate learning of patients, other house staff/students and others.
III. SERVICE OBJECTIVES
It must be recognized that trainees perform an important and major hospital service. This aspect of their
work has occasionally been abused. Care must be taken to ensure that the inevitable demands for routine
service work are either limited or rewarded by active teaching. It is the view of the surgical PGY I co80
coordinator that the only experience of no value to a PGY I trainee is a large volume of routine work which is
conducted in complete isolation from other medical staff.
The service load of the trainee will be limited to that set out below in achievement of educational objectives.
IV. THE HEALTH SCIENCES CENTRE
GENERAL SURGERY
The general surgical unit is on the 4th floor of the Health Sciences Centre. The ward is shared with the
Plastic Surgery service and the house staffs on General Surgery and Plastics cross-cover at nights and
weekends.
The normal complement of house staff is: one chief resident, two assistant residents and two clinical clerks
on General Surgery and one or two residents on Plastics.
The PGY I trainee takes call in rotation, which is normally one night in four, and has the opportunity to see
patients in the Emergency Room and to discuss them directly with his staff person on call.
The service offers a complete mix of general surgical patients. The Plastic Service is heavily weighted in
favour of hand and facial trauma and the on-call cover offers a unique opportunity to learn the basic
principles in managing these areas.
The General Surgery service has particular strength in the management of major trauma, endocrine surgery,
laparoscopic surgery and in surgical oncology. In addition, there is a good opportunity to gain exposure to
vascular access surgery. The Health Sciences Centre is the Provincial Referral Centre for major trauma and
burns
Attending Staff
Dr. D. Boone
Dr. M. Hogan
Dr. A. Kwan
Dr. D. Pace
Dr. M. Wells
Resources
The five general surgeons are full-time University professors. Each of the general and plastic surgeons has
one half-day clinic per week. The PGY I trainee is expected to attend the General Surgery clinics.
Each surgeon has one full-day for elective surgery in addition to time in Day Surgery for minor procedures
and time in the endoscopy unit.
Formal Teaching
1.
Surgical rounds are held weekly on Tuesday mornings at 0745 hours in Lecture Theatre B. These
are usually case-based discussions and oriente3d to participatory teaching of the house staff and
surgeons.
2.
Surgical resident seminars are Friday afternoons at 1530 hours. These sessions are directed to
General Surgery resident but any PGY I trainee is welcome to attend, and are usually held at St.
Clare’s Mercy Hospital, Morrissey Wing, third floor.
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3.
There is a schedule for clinical clerk teaching done a weekly basis and PYG I trainees are welcome
to attend.
4.
Principles of Surgery rounds are on Wednesdays at 1600 hours. They may be held in Lecture
Theatre B, the Anatomy Lab or the Surgical Research Lab, according to the schedule posted on the
Surgery website. These sessions are for junior residents and any PGY I trainee who is interested in
attending.
5.
All General Surgery Rounds except those directed at clinical clerks are listed under “News & Events”
on the Discipline of Surgery website. The clerkship Teaching Schedule may be obtained from the
Office of Surgical Education, 777-6874 or [email protected]. While PGY I’s are on a General
Surgery rotation, the rounds they are expected to attend should be on their One45 calendar.
Specific Objectives which may be achieved
1. To know the general preparation of the patient for surgery.
2. To demonstrate knowledge of the general conduct of surgical operations including principles of asepsis
and perioperative therapy.
3. Be able to perform, under supervision, simple suturing and surgery of “lumps and bumps”.
4. To know the principles in surgical and non-operative management of trauma, gastro-intestinal disease,
breast and thyroid disease and surgical oncology.
5. To demonstrate communication skills with patients and families including the breaking of bad news and
discussion of prognosis.
6. To know principles of informed consent.
7. To know the principles in post-operative care including the recognition of complications and the
management of the more common ones.
8. To recognize and know the principles in treating sepsis, the acute abdomen, major trauma and the
common cancers of the breast and G.I. tracts.
ORTHOPEDIC SURGERY
The trainee is exposed to the management of major and minor trauma cases as well as elective orthopedic
cases. There are daily clinics where the house staff see both new and re-check patients and gain
experience in the examination, treatment and follow-up of various orthopedic conditions.
The workload and teaching is shared with orthopedics and/or general surgery residents and clinical clerks.
Trauma rounds are held weekly and attendance at these is expected. Other orthopedic surgery rounds as
listed under “News & Events” on the Discipline of Surgery’s website.
Attending Staff
Dr. A. Furey
Dr. G. Hogan
Dr. R. Martin
Dr. F. Noftall
Dr. F. O’Dea
Dr. P. Rockwood
Dr. D. Squire
Dr. C. Stone
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NEUROSURGERY
A clinical associate is generally assigned to this service. This is a busy clinical service and regular teaching
activities are available. These include neurosurgery and neurology rounds, a didactic series of lectures
conducted by Dr. Maroun, and the various other surgical teaching rounds within the General Hospital.
Attendance in the operating room is not essential but the surgeons do make a point of having the house staff
come to see relevant pathology. There is excellent exposure to clinical problems in OPD (4 clinics per
week).
Attending Staff
Dr. R. Avery
Dr. A. Engelbrecht
Dr. F. Maroun
Dr. G. Murray
UROLOGY
The service offers a highly organized, highly structured rotation with daily teaching rounds and tutorials. The
clinical responsibility given to the trainee is high, allowing familiarization with a wide range of urological
pathology. Trainees who have completed the service rate it highly because of the responsibility given to
them and the relevance of what they learn to almost any area of medicine in which they might choose to
practice.
Attending Staff
Dr. L. Best
Dr. D. Drover
Dr. G. Duffy
Dr. C. French
Dr. R. Hewitt
V. ST. CLARE'S MERCY HOSPITAL
GENERAL SURGERY
The general surgical service at St. Clare's Mercy Hospital is very busy and accommodates, in addition to
general surgery, a large volume of vascular surgery, thoracic surgery, plastic surgery and endoscopy. One
or two trainees are assigned and the heavy individual case load, as well as the wide variety of major and
minor surgical cases encountered, makes this a very satisfactory and popular rotation.
Teaching session s include:
1.
Daily bedside rounds are conducted by the staff surgeons.
2.
Surgical rounds are held weekly on Tuesday mornings at 0745 hours in Lecture Theatre B at the
HSC. These are usually case-based discussions and oriented to participatory teaching of the house
staff and surgeons.
3.
Surgical resident seminars are Friday afternoons at 1530 hours. These sessions are directed t to
General Surgery residents but any PGY I trainee is welcome to attend, and are usually held at St.
Clare’s Mercy Hospital, Morrissey Wing, third floor.
4.
There is a schedule for clinical clerk teaching done on a weekly basis and PGY I trainees are
welcome to attend.
83
5.
Principles of Surgery rounds are on Wednesdays at 1600 hours. They may be held in Lecture
Theatre B, the Anatomy Lab or the Surgical Research Lab, according to the schedule posted on the
Surgery website. These sessions are for junior residents and any PGY I trainee who is interested in
attending.
6.
All General Surgery Rounds except those directed at clinical clerks are listed under “News & Events”
on the Discipline of Surgery website. The Clerkship Teaching Schedule may be obtained from the
Office of Surgical Education, 777-6874 or [email protected]. While PGY I’s are on a General
Surgery rotation, the rounds they are expected to attend should be on their One45 calendar.
7.
Vascular Surgery Rounds are held on Mondays, 0730 hours in the 5E Conference Room, SCM. In
addition to the one or two trainees, there is always a chief resident as well as two or three junior
residents in general surgery. Two or three clinical clerks, as well, are assigned to the staff surgeons
at St. Clare's Mercy Hospital. Trainees work a call rotation with the residents; the chief resident and
the staff surgeon on call are always available. There are two general surgery teams, one
general/thoracic team and one vascular team.
Attending Staff
Team A (General)
Dr. A. Felix
Dr. W. Pollett
Team B (General)
Dr. M. Hogan
Dr. A. Kwan
Dr. D. Pace
Dr. M. Wells
Team C (Thoracic)
Dr. P. Gardiner
Dr. C. Mann
Team D (Vascular)
Dr. G. Browne
Dr. K. Melvin
ORTHOPEDIC SURGERY
The PGY I trainee (or family practice resident) will gain experience in the multi-disciplinary approach to
orthopedic diseases, with greater emphasis on elective conditions and some trauma.
Daily orthopedic clinics are organized for teaching, and house staff can gain experience in simple orthopedic
procedures and cast application. The workload is shared with orthopedics and/or general surgical residents
and clinical clerks.
Attendance and participation is expected at Tuesday am (HSC), Thursday am (HSC) and Friday am (JCH)
teaching rounds.
Attending Staff
Dr. A. Furey
Dr. G. Hogan
Dr. R. Martin
Dr. F. Noftall
Dr. F. O’Dea
Dr. P. Rockwood
Dr. D. Squire
Dr. C. Stone
VI. ELECTIVES
PLASTIC SURGERY - THE HEALTH SCIENCES CENTRE
84
Plastic surgery at the Health Sciences Centre is a separate service. A wide variety of general plastic surgery
as well as microvascular, hand and cosmetic surgery is performed. Rotating trainees are not regularly
assigned to this service but are welcome as elective students.
Many outpatient minor operative procedures which are done through day care surgery, the chance for the
trainee who often times will first assist on more major cases in the main operating room and the willingness
of the staff surgeons to teach, make this surgery elective quite attractive to the trainee.
Attending Staff
Dr. J. Cluett
Dr. D. Fitzpatrick
Dr. D. Jewer
Dr. A. Rideout
PEDIATRIC SURGERY - JANEWAY CHILDREN’S HEALTH AND REHABILITATION CENTRE
Pediatric Surgery is available as an elective surgical rotation. There is a great deal of clinical material
available on the surgical service, material which is usually only seen in a pediatric hospital.
Regular teaching rounds are carried out three times a week. There is a grand surgical round rotating with all
specialties in pediatric surgery weekly. Mortality rounds are held once a month and there is a one-hour
teaching session each week correlating embryology, physiology and anatomy with pediatric surgical
problems.
Electives can be arranged by contacting Dr. David Price, Chief of Surgery, Janeway Children’s Health and
Rehabilitation Centre.
VII. PLAN FOR ACHIEVING EDUCATIONAL OBJECTIVES
1.
Inpatient Bedside Service: The trainee must be the member of the surgical team who is
responsible for the day-to-day bedside management of the surgical patients. In this, he/she is
supervised and assisted by the residents and staff persons and in turn supervises and is assisted by
the clinical clerks.
Trainees must be involved in formulation of plans of management. As far as possible, orders should
be channeled through the trainee. There should be regular informal bedside teaching and work
rounds.
2.
Operating Room: Trainees should go to the OR with most of the patients under their care. They
need not always be present throughout the procedure but should always consult with the resident or
staff person if they feel that their presence is of no use or their time would be better spent on the
ward. The surgeons must get used to the idea of getting trainees out of the OR when there is no
point in their presence.
3.
Outpatient Clinic Attendance: Some staff persons have well-organized clinics and can
demonstrate principles of outpatient care. These clinics should always be attended by trainees.
Please see Appendix Two: A guide to Developing Good Clinical Skills and Attitudes for more information.
85
SECTION 3
Specific Rotation Objectives
86
Angiography/Interventional Radiology
SUPERVISOR:
Dr. Peter Collingwood, HSC
SUPERVISOR:
Dr. Adrian Major, SCM
The following is an outline of the goals and objectives of the Interventional Radiology rotation during PGY3,
incorporated into CANMEDS format. The CANMEDS roles will be assessed throughout all rotations and will
remain consistent throughout all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
DUTIES AND RESPONSIBILITIES
•
•
•
•
To understand the rationale for interventional procedures for each patient.
To have an expectation of expected positive outcomes and possible complications.
To fully understand the anatomy of the organ systems involved in each intervention.
To be able to obtain informed consent and discuss the case appropriately with the patient and family
members if necessary.
• To review requests for in-patient procedures and to make recommendations as to the appropriate
investigation and intervention with the approval of the staff interventionalist.
• To be exposed to a wide variety of angiographic and interventional procedures as possible during the
rotation and participate in the procedures with the staff interventionalist.
• To understand interventional techniques.
• To report these examinations in a timely fashion under the supervision of the staff interventionalist.
• To supervise the pre and post-procedure care of inpatients and outpatients in conjunction with the
staff radiologist.
ONE 4-WEEK ROTATI2 (OR SECOND 4-WEEK ROTATION)
SUGGESTED READING LIST
(Copies of the suggested reading can be obtained through either Dr. Heale or Dr. Collingwood)
•
•
•
•
1.
Imaging Atlas of Human Anatomy – Weir & Abrahams
Vascular & Interventional Radiology – Kaufman & Lee
Introduction to Cerebral Angiography – Osborn
SIR syllabiMedical Expert
Have thorough working knowledge of the anatomy of the vascular, biliary and urologic systems and
other necessary anatomy. The vascular anatomy includes the aorta and its major branches as well
as the vascular anatomy of the brain and neck.
Understand the pathophysiology of atherosclerosis and be familiar with the techniques of vascular
recanalization including angioplasty stenting and thrombolysis.
87
Become competent in basic interventional techniques especially with respect to accessing the
femoral artery and central and peripheral veins to gain some understanding of basic interventional
devices.
Gain an understanding of the IR role in hemodialysis patients, especially as it relates to access
problems regarding, native fistulas, grafts, and central lines.
Understand the various central venous access techniques and devices used in IR.
Gain an understanding in urologic interventions, including percutaneous nephrostomy and antegrade
stenting. This includes the indications for and the complications of the procedure.
Gain an understanding in biliary interventions including percutaneous transhepatic cholangiography,
percutaneous biliary drainage and stenting. This includes the indications for and the complications of
the procedure.
Understand the rationale for catheter neuroangiography and be able to identify the major vessels.
Become familiar with conscious sedation and analgesia and be able to manage complications of
intravenous sedation.
Be familiar with contrast reactions and their treatment.
Become familiar with contrast injection rates and volumes for angiographic procedures.
Be able to independently perform an angiograph examination of the abdominal aorta and lower
extremities.
Gain knowledge of how to perform an angiographic procedure including contrast injection volume
and rates and the indications for antibiotic prophylaxis.
Be able to perform a cerebral angiogram (PGY4 & PGY5).
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers, including IR
technologists and nurses.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish effective relationships with patients and be able to obtain informed consent for
interventional procedures.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information. Handles conflict situations well.
Produce succinct reports that describe findings, most likely diagnosis and interventions performed.
Complete records and reports effectively, as well as oral presentations.
88
3.
Collaborator
Gain an understanding of the role of Interventional Radiology in patient care.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Contribute to interdiscipline activities and rounds.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition residents will be required to be active participants in inter and intra
discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Recognize the benefits and risks of interventional investigations including the risks and benefits of
interventional radiology procedures versus surgical options.
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (mammography, lung cancer, colon cancer, cardiac
calcification and total body).
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
89
Understand the importance of self responsibility and the responsibility a radiologist has to patients,
referring physicians and the community.
Have a personal commitment of continued education and demonstrate a commitment to the need for
continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long
term plan. For a resident, this would include seeing as many cases as possible during the days with
follow-up reading performed at night.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
90
Body Imaging (HSC): Introductory Month – PGY2
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Body Objectives in PGY5 below)
SUPERVISOR:
Dr. Diane Colbert, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
Understand the basic physics of CT including pitch, slice thickness, mA and kV, scanner types.
Learn principles and effects of contrast enhancement, timing and its applications.
Learn to appropriately protocol and oversee studies.
Learn appropriate form of dictation.
Be able to recognize and effectively treat all forms of adverse contrast reactions.
Be able to interpret basic CT pathology.
Be studied in CT anatomy.
Understand the importance of radiation dose & when it is appropriate (or Not) to use CT as a diagnostic tool.
Be able to effectively carry out these goals while maintaining professionalism.
91
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols. Silverman PM.
Lippincott-Raven.
1.
Medical Expert
Be able to identify the CT appearances of:
- Obstructive uropathy secondary to ureteric calculus
- Renal cystic disease
- Renal cell carcinoma
- Adrenal masses and adenoma
- Liver cirrhosis
- Hepatic hemangioma
- Liver cancer – primary and metastatic
- Biliary obstruction, gallstones
- Pancreatitis and complications
- Pancreatic cancer
- Bowel and gastric cancer
- Bowel obstruction
- Visceral Perforation – free air
- Lymphoma
- Ovarian cancer
- Cervical, uterine cancer
- Prostate cancer
- Omental disease
- Aortic aneurysm and dissection
- Ascites
- Trauma – liver, spleen, kidney, bowel , bladder, arterial injury
- Appendicitis
- Bladder carcinoma, TCC, CT urography
- Inflammatory bowel disease and its complications
- Pseudomembranous and other forms of colitis
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
- Triple phase CT of the liver/kidneys,
- Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or
pancreatic tumor )
- CT urogram
92
- Adrenal washout study
- CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Adequately assess & interpret CT images of the intra-abdominal & pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which
in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body
MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
-
Solitary and multiple hepatic lesion(s), including those of the biliary tree
Fatty infiltration of the liver
Biliary duct dilatation
Cirrhosis/Portal hypertension
Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
Ascites
Gallbladder wall thickening
Solitary and multiple splenic masses
Splenomegaly
Pancreatic mass
Pancreatitis
Adrenal mass, hypertrophy and hemorrhage
Renal mass including both benign and malignant causes
Masses of the renal collecting system and bladder
Hydronephrosis
Nephrolithiasis/Nephrocalcinosis
Omental caking/Peritoneal disease
Pseuodomyxoma peritoneum
Lymph node enlargement
Bowel wall thickening, including infectious and inflammatory causes such as IBD
Bowel obstruction, diagnosis and determination of etiology
Pneumoperitoneum
Mesenteric masses, including such tumors as Carcinoid
Aortic aneurysm/dissection
Pelvic mass (including uterine/adnexal masses)
Prostatic carcinoma and hypertrophy
Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
93
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
Body Imaging (HSC): PGY3
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Body Objectives in PGY5 below)
SUPERVISOR:
Dr. Diane Colbert, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
To expand on those listed as a PGY2.
Continue to build on interpretative skills.
Effectively identify life threatening findings and notify appropriate staff.
Be able to direct and protocol choice of test and change if necessary.
Be able to consent patients and participate in image guided procedures.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
94
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
Silverman PM. Lippincott-Raven.
1.
Medical Expert
Expand on those listed as a PGY2.
Be able to identify:
-
Abscess – liver, pancreatic, renal, bowel
Carcinomatosis
Cholangiocarcinoma
Budd-Chiari Syndrome
Closed loop obstruction
FNH, HCC, adenoma of liver
Pancreatic Islet cell tumours
Cystic Pancreatic neoplasms
VHL and MEN syndromes
Pseudoanuerysms
Retroperitoneal fibrosis
Bowel ischemia and pneumatosis intestinalis
Carcinoid and carcinoid syndrome
Polysplenia syndromes and findings
Congenital anomalies
CT urography and enterography
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial
planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in
turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI
studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
-
Triple phase CT of the liver/kidneys,
Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or
pancreatic tumor )
CT urogram
Adrenal washout study
CT aortic protocol (for assessment of dissection, anueyrsm leak/rupture)
95
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
-
Solitary and multiple hepatic lesion(s), including those of the biliary tree
Fatty infiltration of the liver
Biliary duct dilatation
Cirrhosis/Portal hypertension
Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
Ascites
Gallbladder wall thickening
Solitary and multiple splenic masses
Splenomegaly
Pancreatic mass
Pancreatitis
Adrenal mass, hypertrophy and hemorrhage
Renal mass including both benign and malignant causes
Masses of the renal collecting system and bladder
Hydronephrosis
Nephrolithiasis/Nephrocalcinosis
Omental caking/Peritoneal disease
Pseuodomyxoma peritoneum
Lymph node enlargement
Bowel wall thickening, including infectious and inflammatory causes such as IBD
Bowel obstruction, diagnosis and determination of etiology
Pneumoperitoneum
Mesenteric masses, including such tumors as Carcinoid
Aortic aneurysm/dissection
Pelvic mass (including uterine/adnexal masses)
Prostatic carcinoma and hypertrophy
Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
96
Body Imaging (HSC): PGY4
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Body Objectives in PGY5 below)
SUPERVISOR:
Dr. Diane Colbert, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
To expand on the knowledge of CT anatomy and Pathology obtained in the first 2 rotations.
Participate in CT guided procedures.
Effectively be able to use CT fluoroscopy.
Be able to correlate CT and MRI findings and determine how they relate to each case and patient diagnosis.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
97
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
Silverman PM. Lippincott-Raven.
1.
Medical Expert
Expand on those listed as a PGY3.
Identify the CT appearance of and interpret:
-
CT angiography
CT Urography
CT Enterography
Endovascular stent placement and endoleak
Renal artery stenosis
Complicated Bowel obstruction
Pneumatosis intestinalis
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial
planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in
turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI
studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
-
Triple phase CT of the liver/kidneys,
Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or
pancreatic tumor )
CT urogram
Adrenal washout study
CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
-
Solitary and multiple hepatic lesion(s), including those of the biliary tree
Fatty infiltration of the liver
Biliary duct dilatation
Cirrhosis/Portal hypertension
Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
Ascites
Gallbladder wall thickening
Solitary and multiple splenic masses
98
-
Splenomegaly
Pancreatic mass
Pancreatitis
Adrenal mass, hypertrophy and hemorrhage
Renal mass including both benign and malignant causes
Masses of the renal collecting system and bladder
Hydronephrosis
Nephrolithiasis/Nephrocalcinosis
Omental caking/Peritoneal disease
Pseuodomyxoma peritoneum
Lymph node enlargement
Bowel wall thickening, including infectious and inflammatory causes such as IBD
Bowel obstruction, diagnosis and determination of etiology
Pneumoperitoneum
Mesenteric masses, including such tumors as Carcinoid
Aortic aneurysm/dissection
Pelvic mass (including uterine/adnexal masses)
Prostatic carcinoma and hypertrophy
Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify cunard segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
99
Body Imaging (HSC): PGY5
SUPERVISOR:
Dr. Diane Colbert, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
DUTIES AND RESPONSIBILITIES
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
To expand on the knowledge of CT anatomy and Pathology obtained in the first 3 rotations.
Effectively perform CT guided procedures and manage complications.
Assist other residents in their interpretation, teaching and management of the daily CT worklist.
Be able to correlate CT and MRI findings and determine how they relate to each case and patient diagnosis.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
Silverman PM. Lippincott-Raven.
100
1.
Medical Expert
Be proficient in CT interpretation and the management of CT diagnosed pathology.
Be able to identify and give appropriate differential diagnosis for CT findings.
Continue to expand on knowledge from all previous Body rotations.
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial
planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in
turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI
studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
-
Triple phase CT of the liver/kidneys,
Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or
pancreatic tumor )
CT urogram
Adrenal washout study
CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
-
Solitary and multiple hepatic lesion(s), including those of the biliary tree
Fatty infiltration of the liver
Biliary duct dilatation
Cirrhosis/Portal hypertension
Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
Ascites
Gallbladder wall thickening
Solitary and multiple splenic masses
Splenomegaly
Pancreatic mass
Pancreatitis
Adrenal mass, hypertrophy and hemorrhage
Renal mass including both benign and malignant causes
Masses of the renal collecting system and bladder
Hydronephrosis
Nephrolithiasis/Nephrocalcinosis
Omental caking/Peritoneal disease
101
-
Pseuodomyxoma peritoneum
Lymph node enlargement
Bowel wall thickening, including infectious and inflammatory causes such as IBD
Bowel obstruction, diagnosis and determination of etiology
Pneumoperitoneum
Mesenteric masses, including such tumors as Carcinoid
Aortic aneurysm/dissection
Pelvic mass (including uterine/adnexal masses)
Prostatic carcinoma and hypertrophy
Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
2.
Communicator
Be an effective communicator with referring clinicians and house staff.
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
102
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to
choose the most appropriate investigation.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
103
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
104
Body Imaging (SCM) need to put in updated ones
SUPERVISOR:
Dr. Connie Hapgood, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
DUTIES AND RESPONSIBILITIES
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging
and MRI.
Residents will review all CT/MRI requisitions with the responsible staff radiologist when able and record the
examination plan on the requisition.
The resident will review each CT/MRI examination, present it to the staff radiologist for discussion, and
dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage
under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT
guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
1.
Medical Expert
Know the indications, limitations/complications and be able to plan, interpret, and report the following
CT studies:
-
Triple phase CT of the liver/kidneys,
Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or
pancreatic tumor )
CT urogram
Adrenal washout study
CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
105
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which
in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body
MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
-
Solitary and multiple hepatic lesion(s), including those of the biliary tree
Fatty infiltration of the liver
Biliary duct dilatation
Cirrhosis/Portal hypertension
Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
Ascites
Gallbladder wall thickening
Solitary and multiple splenic masses
Splenomegaly
Pancreatic mass
Pancreatitis
Adrenal mass, hypertrophy and hemorrhage
Renal mass including both benign and malignant causes
Masses of the renal collecting system and bladder
Hydronephrosis
Nephrolithiasis/Nephrocalcinosis
Omental caking/Peritoneal disease
Pseuodomyxoma peritoneum
Lymph node enlargement
Bowel wall thickening, including infectious and inflammatory causes such as IBD
Bowel obstruction, diagnosis and determination of etiology
Pneumoperitoneum
Mesenteric masses, including such tumors as Carcinoid
Aortic aneurysm/dissection
Pelvic mass (including uterine/adnexal masses)
Prostatic carcinoma and hypertrophy
Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
106
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening.
107
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to
choose the most appropriate investigation.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
108
Pulmonary and Cardiovascular Radiology: PGY2
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Chest Objectives in PGY5 below)
CO -SUPERVISORS:
Dr. Rick Bhatia, Health Sciences Centre
Dr. Scott Harris, Health Sciences Centre
SUPERVISOR:
Dr. Angus Hartery, St. Clare’s (Acting)
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY2, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac
studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
To attend Chest Oncology rounds.
To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES
Report - Chest CT’s
- Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting)
Observe cardiac CT: MRI on Tuesdays*
*
On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
109
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments. All
needed texts and articles are provided and scaled to the resident’s level.
Cardiac Imaging - the requisites
The Royal College also provides the following reading list:
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
“Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read)
“High Resolution CT Scanning” by Műller (Additional Text)
1.
Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Know the anatomy of the heart and coronary arteries.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Become proficient in the interpretation of critical care chest imaging.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Understand the physics of how a chest image is created.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies.
Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Recognize and give the differential diagnosis of at least the following:
•
•
•
•
•
•
•
Lobar collapse
Solitary pulmonary nodule
Multiple pulmonary nodules
Interstitial lung disease
Airspace disease
Mediastinal mass
Pleural fluid
110
•
•
•
•
•
•
•
Pleural mass
Chest wall mass
Pulmonary vascular disease
Cardiac disease: valvular, congenital, myocardial, pericardial
Anomalies/abnormalities of the aorta
Elevation of the diaphragm
Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
Lymphoma
Lung cancer
Metastatic disease to the chest including lymphagitic carcinomatosa
Carcinoid
Extrinsic allergic alveolitis
Occupational lung disease (including silicosis and asbestosis)
Idiopathic pulmonary fibrosis
Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
Sarcoidosis
Alveolar proteinosis
Pulmonary hemorrhage syndromes
Wegener’s granulomatosis
Eosinophillic pneumonia
BOOP
Pulmonary edema
Pulmonary hypertension
Pulmonary embolism
Pneumothorax
Mitral stenosis/regurgitation
Aortic stenosis/regurgitation
Aortic aneurysm
Aortic dissection
Right-sided aortic arch
Congestive heart failure
Thymoma
Superior vena cava obstruction
Pulmonary hematoma
Pulmonary sequestration
Bronchogenic cyst
Pericardial effusion
Mesothelioma
Benign pleural fibroma
Anomalous coronary artery
Bicuspid aortic valve
Ascending thoracic aortic aneurysm
Myocarditis
Hypertrophic cardiomyopathy
ARVD
Partial Anomalous pulmonary venous return
Atrial septal defect
Myocardial Infarction
111
Pulmonary and Cardiovascular Radiology: PGY3
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Chest Objectives in PGY5 below)
CO -SUPERVISORS:
Dr. Rick Bhatia, Health Sciences Centre
Dr. Scott Harris, Health Sciences Centre
SUPERVISOR:
Dr. Angus Hartery, St. Clare’s (Acting)
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY3, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac
studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
To attend Chest Oncology rounds.
To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES
Report - Chest CT’s
- Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting)
Report at least 20 Chest plain films per day.
Report Cardiac CT and MRI’s on Tuesdays*
*
On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
112
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
Cardiac Imaging - the requisites
The Royal College also provides the following reading list:
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
“Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read)
“High Resolution CT Scanning” by Műller (Additional Text)
1.
Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Know the anatomy of the heart and coronary arteries.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Become proficient in the interpretation of critical care chest imaging.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Understand the physics of how a chest image is created.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies.
Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Recognize and give the differential diagnosis of at least the following:
• Lobar collapse
• Solitary pulmonary nodule
• Multiple pulmonary nodules
• Interstitial lung disease
• Airspace disease
• Mediastinal mass
• Pleural fluid
113
•
•
•
•
•
•
•
Pleural mass
Chest wall mass
Pulmonary vascular disease
Cardiac disease: valvular, congenital, myocardial, pericardial
Anomalies/abnormalities of the aorta
Elevation of the diaphragm
Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
• Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
• Lymphoma
• Lung cancer
• Metastatic disease to the chest including lymphagitic carcinomatosa
• Carcinoid
• Extrinsic allergic alveolitis
• Occupational lung disease (including silicosis and asbestosis)
• Idiopathic pulmonary fibrosis
• Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
• Sarcoidosis
• Alveolar proteinosis
• Pulmonary hemorrhage syndromes
• Wegener’s granulomatosis
• Eosinophillic pneumonia
• BOOP
• Pulmonary edema
• Pulmonary hypertension
• Pulmonary embolism
• Pneumothorax
• Mitral stenosis/regurgitation
• Aortic stenosis/regurgitation
• Aortic aneurysm
• Aortic dissection
• Right-sided aortic arch
• Congestive heart failure
• Thymoma
• Superior vena cava obstruction
• Pulmonary hematoma
• Pulmonary sequestration
• Bronchogenic cyst
• Pericardial effusion
• Mesothelioma
• Benign pleural fibroma
• Anomalous coronary artery
• Bicuspid aortic valve
• Ascending thoracic aortic aneurysm
• Myocarditis
• Hypertrophic cardiomyopathy
• ARVD
• Partial Anomalous pulmonary venous return
• Atrial septal defect
• Myocardial Infarction
114
Pulmonary and Cardiovascular Radiology: PGY4
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Chest Objectives in PGY5 below)
CO -SUPERVISORS:
Dr. Rick Bhatia, Health Sciences Centre
Dr. Scott Harris, Health Sciences Centre
SUPERVISOR:
Dr. Angus Hartery, St. Clare’s (Acting)
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY4, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT & MRI examinations including cardiac studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
To attend Chest Oncology rounds.
To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES
Report - Chest CT’s
- Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting).
Report at least 20 Chest plain films per day.
Report Cardiac CT and MRI’s on Tuesdays.*
Report consults.
*
On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
115
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
Cardiac Imaging - the requisites
The Royal College also provides the following reading list:
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
“Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read)
“High Resolution CT Scanning” by Műller (Additional Text)
1.
Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Know the anatomy of the heart and coronary arteries.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Become proficient in the interpretation of critical care chest imaging.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Understand the physics of how a chest image is created.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies.
Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Recognize and give the differential diagnosis of at least the following:
• Lobar collapse
• Solitary pulmonary nodule
• Multiple pulmonary nodules
• Interstitial lung disease
• Airspace disease
• Mediastinal mass
116
•
•
•
•
•
•
•
•
Pleural fluid
Pleural mass
Chest wall mass
Pulmonary vascular disease
Cardiac disease: valvular, congenital, myocardial, pericardial
Anomalies/abnormalities of the aorta
Elevation of the diaphragm
Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
• Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
• Lymphoma
• Lung cancer
• Metastatic disease to the chest including lymphagitic carcinomatosa
• Carcinoid
• Extrinsic allergic alveolitis
• Occupational lung disease (including silicosis and asbestosis)
• Idiopathic pulmonary fibrosis
• Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
• Sarcoidosis
• Alveolar proteinosis
• Pulmonary hemorrhage syndromes
• Wegener’s granulomatosis
• Eosinophillic pneumonia
• BOOP
• Pulmonary edema
• Pulmonary hypertension
• Pulmonary embolism
• Pneumothorax
• Mitral stenosis/regurgitation
• Aortic stenosis/regurgitation
• Aortic aneurysm
• Aortic dissection
• Right-sided aortic arch
• Congestive heart failure
• Thymoma
• Superior vena cava obstruction
• Pulmonary hematoma
• Pulmonary sequestration
• Bronchogenic cyst
• Pericardial effusion
• Mesothelioma
• Benign pleural fibroma
• Anomalous coronary artery
• Bicuspid aortic valve
• Ascending thoracic aortic aneurysm
• Myocarditis
• Hypertrophic cardiomyopathy
• ARVD
• Partial Anomalous pulmonary venous return
• Atrial septal defect
• Myocardial Infarction
117
Pulmonary and Cardiovascular Radiology: PGY5
CO -SUPERVISORS:
Dr. Rick Bhatia, Health Sciences Centre
Dr. Scott Harris, Health Sciences Centre
SUPERVISOR:
DR. ANGUS HARTERY, St. Clare’s (Acting)
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY5, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac
studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
To attend Chest Oncology rounds.
To supervise Chest Radiology rounds when scheduled.
SPECIFIC DAILY DUTIES
Report - Chest CT’s
- Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting).
Report at least 20 Chest plain films per day.
Report Cardiac CT and MRI’s on Tuesdays.*
Report consults
All duties listed above, with the caveat of self directed learning to focus on knowledge gaps and prepare for
exams. Exact goals and duties will be discussed with the resident at the start of the rotation.
*
On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
118
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
Cardiac Imaging - the requisites
The Royal College also provides the following reading list:
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
“Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read)
“High Resolution CT Scanning” by Műller (Additional Text)
1.
Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Know the anatomy of the heart and coronary arteries.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Become proficient in the interpretation of critical care chest imaging.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Understand the physics of how a chest image is created.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies.
Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Recognize and give the differential diagnosis of at least the following:
119
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Lobar collapse
Solitary pulmonary nodule
Multiple pulmonary nodules
Interstitial lung disease
Airspace disease
Mediastinal mass
Pleural fluid
Pleural mass
Chest wall mass
Pulmonary vascular disease
Cardiac disease: valvular, congenital, myocardial, pericardial
Anomalies/abnormalities of the aorta
Elevation of the diaphragm
Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
Lymphoma
Lung cancer
Metastatic disease to the chest including lymphagitic carcinomatosa
Carcinoid
Extrinsic allergic alveolitis
Occupational lung disease (including silicosis and asbestosis)
Idiopathic pulmonary fibrosis
Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
Sarcoidosis
Alveolar proteinosis
Pulmonary hemorrhage syndromes
Wegener’s granulomatosis
Eosinophillic pneumonia
BOOP
Pulmonary edema
Pulmonary hypertension
Pulmonary embolism
Pneumothorax
Mitral stenosis/regurgitation
Aortic stenosis/regurgitation
Aortic aneurysm
Aortic dissection
Right-sided aortic arch
Congestive heart failure
Thymoma
Superior vena cava obstruction
Pulmonary hematoma
Pulmonary sequestration
Bronchogenic cyst
Pericardial effusion
Mesothelioma
Benign pleural fibroma
Anomalous coronary artery
120
•
•
•
•
•
•
•
•
2.
Bicuspid aortic valve
Ascending thoracic aortic aneurysm
Myocarditis
Hypertrophic cardiomyopathy
ARVD
Partial Anomalous pulmonary venous return
Atrial septal defect
Myocardial Infarction
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
121
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
122
Emergency Radiology: PGY2
SUPERVISOR:
Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the Emergency rotation during PGY2, incorporated
into CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
DUTIES AND RESPONSIBILITIES:
At the beginning of the rotation, the ER resident will inform the ER department of his/her responsibility to
help organize, coordinate, recommend and whenever possible report appropriate diagnostic imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner,
whether dealing with patients, colleagues, or health care workers.
The ER resident must review cross sectional exams with staff in a timely fashion, and in an urgent/emergent
fashion, should the patient’s condition (or ER physician) dictate the same.
A verbal report must be provided to the responsible ER physician for major findings that are detected; the
details of this communication must be then acknowledged subsequently at the end of the generated report
(i.e. time and date of verbal report and the physician’s name receiving the verbal report).
The ER resident will present cases to staff in a prepared, organized fashion.
The ER resident will be responsible to prepare 2 ER cases, on Powerpoint (in an ICR format) from a
provided list, to the ER supervisor by the end of the rotation.
The resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where
applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
SPECIFIC DAILY DUTIES
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so
can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
The ER Resident will review at least 20 ER PF day with the staff designated in the ER Plain Film category
contained in the Work Rota. When there is no staff designated in this slot, then the review can occur with the
staff designated in the standard Plain Film slot.
The ER resident will review the ER renal colic CT exams ordered the evening before, but performed the
morning after, with the designated CT body staff for that day.
123
Whenever possible, the ER resident is responsible to report any cross sectional studies that have been
performed on patients from the ER, with the designated staff for that day (i.e. ER renal US with the
radiologist covering US that day).
REQUIRED READING LIST
Please note: The books needed will be provided from Dr. Jeon at the beginning of the rotation and must be
returned on the final day of the rotation.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Emergency Radiology: Case Review Series -Stuart E. Mirvis MD FACR (Author), Kathirkamanathan
Shanmuganathan MD (Author), Lisa A. Miller MD (Author), Clint W. Sliker MD (Author)
Emergency Radiology: The Requisites (Requisites in Radiology)-Jorge A Soto MD (Author), Brian Lucey MD
(Author)
SUGGESTED READING LIST
Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, Fourth
Edition, 2000
.
Harris JH, Mirvis SE. The Radiology of Acute Cervical Spine Trauma. Williams and Wilkins, Baltimore, MD,
Third Edition, 1995.
McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.
Mirvis SE, Young JWR. Imaging in Trauma and Acute Care. Williams and Wilkins, Baltimore, MD, 1992.
Novelline RA. Advances in Emergency Radiology, Volumes I and II, Radiological Clinics of North America.
WB Saunders, Philadelphia, PA, 1999.
Stern EJ. Trauma Radiology Companion. Lippincott-Raven, Philadelphia, PA 1997.
West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency and Trauma Radiology.
American Roentgen Ray Society, 2000
1.
Medical Expert
After completing this rotation, the resident should be able to:
1. Identify and describe the basic PF/CT/US anatomy (where applicable) of the CNS, Respiratory,
Cardiovascular, Abdominal/Pelvic (including GI, GU and OB/Gyne), and MSK systems.
2. Discuss the ER radiology Curriculum after studying the accompanying ER Core Curriculum and
content structure/suggested readings: ( see appendix 1)
A
Central Nervous System - 3
B.
Face and Neck -5
C.
Spine: -7
D.
Chest - 8
E.
Cardiovascular -10
124
F.
G.
H.
I.
J.
K.
Abdomen -12
Gynecological and Obstetrical - 14
Male Genitourinary -16
Upper Extremity -17
Pelvis and Hip -19
Lower extremity -21
3. Develop and master a systematic approach to the interpretation of plain radiographs of the spine,
chest and abdomen.
4. Discuss in detail the various CT/US imaging protocols used in the ER rotation.
5. Distinguish abnormal from normal findings on PF( where applicable)/ CT images of the brain,
head/neck and spine regions and to recognize the major disease processes that occur in these areas
particularly in the following areas :
a. Extra-axial hemorrhage
i. Subdural hematoma
ii. Epidural hematoma
b. Parenchymal Injuries
i. Cortical Contusion/traumatic hemorrhage
ii. Diffuse Axonal Injury
iii. Brainstem Injury
c. Non-traumatic Hemorrhage
i. Subarachnoid Hemorrhage
ii. Parenchymal Hemorrhage
d. Herniation Syndromes
e. Cerebral Infarction
f. CNS Infections
g. Spinal trauma
h. Facial Fractures
i. Acute Infections of the Sinuses and Neck
6. Distinguish abnormal from normal findings on PF/US/CT ( where applicable) images of the chest,
and to recognize the major disease processes that occur in these areas particularly in the following
areas :
a. Aorta
i. Trauma
ii. Dissection
iii. Aneurysm
b. Pulmonary Edema
c. Thrombo-embolic Disease
i. Pulmonary Embolism
ii. Deep Vein Thrombosis
d. Pericardial Effusion/Tamponade
e. Pneumothorax/Pneumomediastinum
7. Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the abdomen
and pelvis and to recognize the major disease processes that occur in these areas particularly in the
following areas:
a. Abdominal Trauma:
125
i.
ii.
iii.
iv.
v.
vi.
Solid/Hollow Visceral Injuries
Hemoperitoneum/Intraperitoneal Fluid
Intraperitoneal /Retroperitoneal Hemorrhage
Gas Collections –intraluminal and extraluminal
Bowel and Mesenteric Injuries
Abdominal Wall and Diaphragmatic Injuries
b. Non-Traumatic Abdominal Emergencies
i. The Peritoneal Cavity
• Ascites
• Abscess
• Peritonitis
ii. Liver and Biliary Tract
• Jaundice
o Obstructive and Non-obstructive
• Cholecystitis
iii. Pancreatitis
iv. GI Tract
• Bowel Obstruction
• Bowel Infarction
• Bowel Infection
o Appendicitis
o Diverticulitis
o Infectious Enteritis/Colitis
• Inflammatory Bowel Disease
o Crohn
o Ulcerative Colitis
• Epiploic Appendagitis/Omental Infarction
v. GU
•
•
Urinary Tract Calculi
Infection
o Renal Abscess
o Pyelonephritis
8. Distinguish abnormal from normal findings on Gynecologic Imaging of the pelvis and to recognize the
major disease processes that occur in these areas particularly in the following areas:
a. Ovarian Torsion
b. Ovarian Cystic Disease
c. Pelvic Inflammatory Disease
d. Endometritis
e. Subchorionic Hemorrhage
f. Spontaneous Abortion/Fetal Demise
g. Ectopic Pregnancy
9. Distinguish abnormal from normal findings in imaging the male GU system and to recognize the male
GU emergencies that occur in these areas particularly in the following areas:
126
a. Traumatic
i. Urethral/Penile
ii. Scrotal/Testicular
b. Acute Non-traumatic Scrotal Conditions
i. Testicular Torsion
ii. Epidydimitis
iii. Orchitis
iv. Infarction
v. Acute Scrotal Fluid Collections
• Hydrocele
• Pyocele
• Hematocele
vi. Testicular Abscess
vii. Fournier’s Gangrene
10. Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the MSK
system and to recognize the major disease processes that occur in these areas particularly in the
following areas:
a. Upper Extremity
i. Scapular/Clavicular fractures
ii. Shoulder/Elbow Dislocations
iii. Forearm fractures /dislocations
iv. Metacarpal/Carpal fractures/dislocations
b. Pelvis and Hip
i. Pelvic Ring Fractures
ii. Isolated Pelvic Fractures
iii. Acetabular Fractures
iv. Hip fractures/disloctions
v. Femoral Fractures
vi. Septic Arthritis
vii. AVN
c. Lower Extremity
i. Tibial Fractures
1. Plateau
2. Plafond
ii. Ankle Injuries
iii. Patellar Injuries
iv. Knee Dislocations
v. Talar/Subtalar Fracture/Dislocation
vi. Tarso-metatarsal dislocation ( Lis Franc)
vii. Metatarsal Fracture/Dislocation
viii. Septic Arthritis
11. Develop a systematic approach in the CT evaluation of a patient involved in multi trauma.
12. Gain knowledge of anatomy and pathology related to organ systems commonly involved in trauma
including the brain, spine, chest, abdomen and pelvis, cardiovascular and musculoskeletal system. (
See objectives for specific topics)
127
13. Have film reading ability of plain film examinations from the Emergency Room as well as Ultrasound
and CT examinations ordered through the Emergency Room.
14. Be able to recommend an appropriate imaging study in an emergency situation.
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
128
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
129
Gastrointestinal – Abdominal Imaging: PGY2 & PGY5
SUPERVISOR:
SUPERVISOR:
Dr. Dianne Colbert, Health Sciences Center
Dr. Geoff Higgins, St. Clare’s
The following is an outline of the goals and objectives of the Gastrointestinal and Abdominal Imaging
rotation during PGY2 and PGY5, incorporated into CanMEDS format. These roles will be assessed and
remain consistent throughout the rotations as a PGY2 and PGY5, with the expectation that skills will be
further developed as a PGY5.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained at each stage of training will be given during the last week. The
examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The
inability to pass the exam could render the rotation incomplete, and the rotation will be completed at
a later date.
DUTIES AND RESPONSIBILITIES
Residents are required to perform 5 screening lists per week and to perform all GI specific procedures.
The resident may be asked to perform other fluoroscopic studies when there is no other resident assigned to that
specific procedure rotation.RST 4-WEEK ROTATI2 (OR SECOND 4-WEEK ROTION)
Outline and discuss the different imaging modalities available and their appropriate indications in the
comprehensive evaluation of the abdomen.
Identify, describe, and discuss the following:
1. Peritoneal fluid
2. Pneumoperitoneum
3. Abdominal calcifications
Acquire a sound knowledge base in and accurately recognize, describe, and discuss the following:
1. Acute Abdomen
2. Small Bowel Obstruction
3. Large Bowel Obstruction
4. Bowel Ischemia and Infarction Abdominal Trauma
5. Lymphadenopathy
6. Abdominopelvic Tumors and Masses
7. AIDS in the Abdomen R ONE
4-WEK ROTATI2 (OR SECOND 4-WEEK ROTATION)
REQUIRED READING LIST
•
•
•
Fundamentals of Diagnostic Radiology Text Readings, Chapter 26 - Pages 733- 755
The Perihepatic Space: Comprehensive Anatomy and CT Features of Pathologic Conditions
RadioGraphics 2007; 27:129–143 Published online
Anatomic CT Demonstration of the Peritoneal Spaces, Ligaments, and Mesenteries: Normal and
Pathologic RadioGraphics 1995; 15:755-770
130
1.
Medical Expert
Gain knowledge of the pharmacology as it relates to barium, gastrografin and glucagon.
Perform, interpret and report upper and lower GI studies including small bowel studies.
Become competent in the interpretation and technical aspects with a focus of attention on plain film
examinations and contrast studies. ONE
Know the indications, limitations and complications and be able to perform, interpret, and report the
following studies:
•
•
•
•
•
•
•
•
•
Double contrast upper gastrointestinal series including esophogram
Small bowel follow-through with screening of terminal ileum
Small bowel enema
Single contrast barium enema
Double contrast barium enema
Gastrograffin swallow / upper GI and enema
T-tube cholangiogram
Sialogram
Interpretation of ERCP
Know the indications and be able to interpret and report an abdominal series.
Know the anatomy and function of the GI tract from the mouth to the anus.
Be able to recognize and give the differential diagnosis of at least the following:
•
•
•
•
•
•
•
•
•
•
•
Pneumoperitoneum, pneumoretroperitoneum
Gas in the biliary tree, portal venous system and pneumotosis intestinalis
Ascites
Abdominal mass
Abdominal calcification
Esophageal, gastric, small and large bowel obstruction
Ileus
Mucosal thickening (i.e., “thumbprinting”)
Strictures
Fistulas and sinus tracts
Abnormalities as seen on contrast studies outlined in Objectives #1 and #2
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of the following:
•
•
•
•
•
•
•
•
•
•
•
Benign masses/lesions of the GI tract including:
Inflammatory ulcers/lesions
Infectious ulcers/lesions
Spindle cell tumours
Polyps
Strictures
Malignant masses/lesions of the GI tract including:
Aden carcinoma, squamous and sarcomas of the GI tract
Carcinoid
Metastatic disease to and from the GI tract
Inflammatory bowel disease
131
•
•
•
•
Ischemic bowel disease
Motility disorders of the GI tract
Congenital anomalies of the GI tract
Diverticulae of the GI tract
Know and recognize the surgical procedures commonly performed on the GI tract, for example:
•
•
•
•
•
2.
Bilroth I and II
Roux-en –Y
Whipple’s procedure
Esophagectomy with gastric pull through
Hemi and total colectomy, A-P resection
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information. Handle conflict situations well.
Produce succinct reports that describe findings, most likely diagnosis and, where appropriate,
recommend further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be an active participant in inter and intra discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
132
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote the health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents will be required to present and teach to other residents, medical students and house staff.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of
care and maintain appropriate professional behaviour.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and applies these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
133
Genitourinary Radiology: PGY2
SUPERVISOR:
Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the GU rotation during PGY2, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
DUTIES AND RESPONSIBILITIES:
At the beginning of the rotation, the GU resident will inform the CR, US and CT departments of his/her
responsibility to help organize, coordinate, recommend and whenever possible report appropriate diagnostic
imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner,
whether dealing with patients, colleagues, or health care workers.
The GU resident must review cross sectional exams with staff in a timely fashion, and in an urgent/emergent
fashion, should the patient’s condition (or attending physician) dictate the same.
A verbal report must be provided to the responsible attending physician for major findings that are detected;
the details of this communication must be then acknowledged subsequently at the end of the generated
report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).
The GU resident will present cases to staff in a prepared, organized fashion and subsequently dictate a
timely concise, accurate report.
The GU resident will be responsible to prepare 2 GU cases, on Powerpoint (in an ICR format) from a
provided list, to the GU supervisor by the end of the rotation.
The resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where
applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
SPECIFIC DAILY DUTIES
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident
doing so can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
The GU Resident will review at least 10 Abdominal/KUB PF day with the staff designated in either of
the ER PF, US or CT categories contained in the Work Rota. When there is no staff designated in the
ER PF slot, then the review can occur with the staff designated in the standard Plain Film slot.
The GU resident will review the ER renal colic CT exams ordered the evening before ( or co-share
with the ER Radiology resident on for the same month), but performed the morning after, with the
designated CT body staff for that day.
134
Whenever possible, the GU resident is responsible to report all GU cross sectional studies (with the
exception of MR) that have been performed on patients, with the designated staff for that day (i.e.
Renal US with the radiologist covering US that day).
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Dunnick, N.R., Sandler, C.M., Newhouse, J.N., Amis, Jr., E.S., Textbook of Uroradiology, 4th ed.,
Philadelphia, PA: Lippincott Williams & Wilkins, 2008.
Zagoria, R.J. Genitourinary Radiology, 2nd edition -- Case Review Series -The Requisites, Mosby, St.
Louis, MO: Mosby, 2004.
Diagnostic Ultrasound: 2-Volume Set. Editors: Carol Rumack (Author), Stephanie Wilson , J. William
Charboneau, Jo-Ann Johnson.
1.
Medical Expert
After completing this rotation, the resident should be able to:
Identify and describe the basic PF/CT/US male/female anatomy (where applicable) of the GU
system.
Discuss the GU radiology curriculum after studying the accompanying GU Core Curriculum and
content structure/suggested readings: (see app. 1)
Review the general developmental anatomy of the male/female GU system.
Discuss in detail the following regarding contrast media:
a)
Understand the physical properties of iodinated contrast media and the physiologic
mechanisms of contrast media excretion.
b)
Learn to screen patients who are at risk from injection of intravascular radiographic contrast
material. Understand the classification, symptoms, and signs of contrast reactions and clinical
management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
i)
Consult the ACR Manual for Contrast Media.
ii)
Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
c)
Understand the indications for premedication and the appropriate regimen to premedicate
contrast sensitive patients including dosages, and dose scheduling
Be able to interpret, identify and/or manage the following with imaging:
a)
Plain abdominal films for bowel gas pattern and recognition of masses/calcification
b)
Renal colic and renal stone disease
135
c)
Hydronephrosis and ureteral obstruction
d)
Urothelial abnormalities including collecting system, ureter, and bladder
e)
Renal cysts and GU tumors including:
i)
The Bosniak Classification for evaluating renal cystic masses and implications for
management of complex renal cysts.
ii)
The imaging and staging of the GU organs including renal, urothelial, prostate,
endometrial, cervical, and ovarian cancers.
iii)
The multi-cystic renal diseases including genetic syndromes such as autosomal
dominant adult polycystic kidney disease and VHL.
f)
Medullary sponge kidney
g)
Bladder diverticula, bladder rupture, neurogenic bladder
h)
Urethral strictures, urethral diverticula
i)
Infectious/Inflammatory diseases of the GU tract including pyelonephritis, XGP and renal
abscess.
j)
Basic cross sectional urinary tract anatomy on CT/CT Urography
Learn conventional imaging protocols of the urinary tract e.g. IVP, RU, VCUG, retrograde
urethrography (RUG), and hysterosalpingography (HSG).
For IVP, the resident should know:
a)
Indications and contraindications for use of abdominal compression.
b)
Routine views and additional films required to achieve the tailored urogram:
Recognize a large variety of congenital abnormalities of the GU/Gyne tract especially the more
common such as:
a. Fusion abnormalities
i. - horseshoe kidney
ii. crossed fused ectopia
iii. ectopic kidney
b. Partial and complete duplications of the collecting systems
c. Renal tubular ectasia ( medullary sponge kidney)
d. Renal Agenesis
e. Hutch Diverticula
f. Uterine Malformations including:
i. Septate
ii. Bicornuate
iii. Uterus Didelphys
Distinguish abnormal from normal findings on Gynecologic Imaging of the pelvis and to recognize the
major disease processes that occur in these areas particularly in the following areas:
136
g.
h.
i.
j.
k.
l.
m.
n.
o.
Ovarian Torsion
Ovarian Cystic Disease
Pelvic Inflammatory Disease
Endometritis
Subchorionic Hemorrhage
Spontaneous Abortion/Fetal Demise
Ectopic Pregnancy
Ovarian, cervical and endometrial cancer
Benign disease of the uterus including leiomyoma, endometriosis and adenomyosis
Distinguish abnormal from normal findings in imaging the male/female GU systems and to recognize
the GU emergencies that occur in these areas particularly in the following areas:
p. Trauma
i. Renal/Bladder
ii. Urethral/Penile
iii. Scrotal/Testicular
iv. Vaginal
q. Acute Non-traumatic Scrotal Conditions
i. Testicular Torsion
ii. Epidydimitis
iii. Orchitis
iv. Infarction
v. Acute Scrotal Fluid Collections
• Hydrocele
• Pyocele
• Hematocele
vi. Testicular Abscess
vii. Fournier’s Gangrene
Understand the importance of the timing of scans for dedicated contrast enhanced CT and MR
imaging of the kidneys to include the corticomedullary, nephrographic and excretory phases.
Initiate, organize, screen and triage the various diagnostic imaging requests that are generated by
the ordering GU clinicians.
Demonstrates an understanding of the fundamental principles of radiation safety, radiation protection
and monitoring.
Displays basic knowledge regarding the approximate doses acquired by common GU procedures.
(see appendix on Contrast media).
Understands the risks and contra-indications to the use of Gadolinium based MR contrast media (
see appendix)
Develop lifelong learning skills to augment knowledge of medicine and Diagnostic Radiology
(recognition of imaging abnormalities with synthesis of clinical and radiological information to arrive
at the correct diagnosis or differential diagnosis)
Progressive increase in radiological knowledge base and continuous learning in GU Radiology
during rotations and case based study.
137
Knowledge of principles of Radiation Physics and Dosimetry (including radiation dose for key
imaging exams)
Ability to use all relevant Resource Materials (Refer to Appendix - Core Reference List of texts,
references, websites, sources for lifelong self-learning)
Knowledge of principles of research design and implementation
Knowledge of how the different imaging modalities produce diagnostic information and their
advantages and limitations.
Have film reading ability of plain film (KUB) examinations as well as GU Ultrasound and CT
examinations ordered through the Emergency Room as well as routine exams.
Be able to recommend an appropriate imaging study in an emergency situation.
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
Skills:
a) Provide an accurate clear and informative radiologic report with a precise diagnosis when possible
or a relevant differential diagnosis with recommendations for follow up or further imaging as
appropriate
b) Directly communicate urgent and unexpected findings with the referring physician or their
representative. Document the communication in the report.
c) Demonstrate effective face to face skills with patients and their families, other physicians, nurses,
technologists and support staff
d) Demonstrate appropriate telephone and digital communication skills
e) Demonstrate skills in obtained written and verbal informed consent
f) Participate in multidisciplinary conferences and radiologic case presentations.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
138
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
Skills:
a) Gather essential and accurate information about patients
b) Gather information from the patient folder, faculty, literature, digital textbooks and internet
c) Develop an imaging plan based on the clinical presentation and available information
d) Perform the appropriate examination with skill and knowledge
e) Demonstrate awareness of impact of ionizing radiation in pregnancy, on germ cells, and for
possible carcinogenesis and demonstrate knowledge of measures to minimize patient exposure
f) Knowledge of alternative imaging modalities, not utilizing ionizing radiation, and their application in
select circumstances
g) Ascertain that the correct procedure is performed on the correct patient
h) Explain the procedure and obtain consent if required.
139
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
Identify strengths, deficiencies, and limits in their knowledge and expertise; set learning and
improvement goals; use multiple sources, including information technology to optimize life-long
learning and support patient care decisions.
Incorporate formative evaluation feedback into daily practice.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
Demonstrate confidentiality wit all information transmitted during a patient encounter.
Demonstrate an understanding of broad principles of biomedical ethics.
Demonstrate positive work habits including punctuality and a professional appearance.
Demonstrate knowledge of issues of impairment (i.e. physical, mental and alcohol and substance
abuse) obligations for impaired physician reporting, and resources and options for care of selfimpairment or impaired colleagues.
140
Mammography: PGY3, PGY4 & PGY5
SUPERVISOR:
Dr. Nancy Wadden, St. Clare’s
The following is an outline of the goals and objectives of the Mammography rotation during residency,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
Residents will be required to interpret mammographic studies as well as perform needle localization and
core biopsy procedures under the supervision of a supervising staff radiologist.
At the end of the final Breast Imaging Rotation, the resident shall be able to adequately address the
following topics. With each rotation leading up to the final rotation, the resident will progress through these
topics.
1.
Organized approach to reading the mammogram.
2.
Image Quality assessment.
3.
Significance of the clinical information.
4.
Anatomy – gross anatomy and histology with mammographic correlation.
5.
Age related changes of the normal breast; effect of HRT.
6.
Recommendation for screening, evidence from RCT, lead time bias, sojourn time, etc.
7.
Epidemiology, risk factors density classifications.
8.
The mammographic report.
9.
Physics:
- focal spot, film/screen, digital, effect and benefit of compression, grids,
radiation dose, etc.
magnification,
10.
MR physics.
11.
Artifacts.
12.
Mammographic positioning – MLO, CC, ML, LM, cleavage, exaggerated CC, change of angle
views, rolled views, etc.
13.
Triangulation.
14.
BiRads lexicon – Mammography, Ultrasound and MRI.
141
15.
Masses – BiRads description.
16.
Masses: multiple vs single:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Cyst
Fibroadenoma
Fat necrosis
Galactocele
Hamartoma
Lymph nodes – benign and malignant
Fibrosis
Hematoma/contusion
Lymphoma
Phyllodes tumor
Malignancy
17.
Pathologic classification of malignancy.
18.
Calcifications – approach.
19.
Ultrasound – indications, benign vs malignant
20.
MRI – indications, benign vs malignant
21.
False negative mammogram.
22.
Interventional procedures:
a.
b.
c.
d.
23.
Core biopsy – stereo, ultrasound, MR
Needle localization
FNA/cyst aspiration
Galactogram
The post surgical breast
a.
b.
c.
Approach to follow-up
Post surgical scar
Radiation changes – acute/subacute/chronic
24.
Breast Cancer Staging
25.
Implants – positioning, normal, rupture, capsular, contracture
26.
Reduction mammoplasty
27.
Nipple and retroareolar tissue
28.
Skin and interstitial changes
29.
The male breast – gynecomastia, carcinoma
30.
Practical exposure to positioning – time spent with technologist
31.
CAR/ACR accresitation
32.
Quality control procedures.
142
1.
Medical Expert
Understand the role of screening mammography and its limitations and applications.
Understand the difference between screening mammography and diagnostic mammography.
Be able to explain the proper technique of mammographic imaging.
Be able to localize the position of a lesion given the standard views.
Plan a diagnostic study (*i.e., select appropriate views).
Be able to manage a patient given the mammographic findings.
Recognize and interpret mammographic abnormalities.
Be able to select appropriate management for a given abnormality.
Perform ultrasound and mammographic guided localization, aspirations and core biopsies.
Describe mammographic abnormalities using the proper lexicon.
Know the anatomy of the female breast including lymphatic drainage routes and physiologic changes
which occur with age.
Know the anatomy of the male breast and how it differs from the female breast.
Distinguish benign features from malignant ones.
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information while handling conflict situations well.
Produce succinct reports that describe findings, most likely diagnosis and where appropriate
recommends further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
143
develop these skills. In addition residents will be required to be active participants in inter and intra
discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and makes use of computer science/information technology as it
pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgement.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (mammography, lung cancer, colon cancer, cardiac
calcification and total body).
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
144
The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long
term plan. For a resident, this would include seeing as many cases as possible during the days with
follow-up reading performed at night.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of
care and appropriate professional behaviour.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
145
MRI: PGY3 & PGY5
SUPERVISOR:
Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the MRI rotation during PGY 3 and 5, incorporated
into CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
DUTIES AND RESPONSIBILITIES:
At the beginning of the rotation, the MR resident will inform the MR operating staff at the Janeway and HSC
of his/her daily responsibility to help initiate, organize, protocol and report appropriate MR imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner,
whether dealing with patients, colleagues, or health care workers.
The MR resident must review all MR abdominal exams with attending staff in a timely fashion, and in an
urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same. The junior
MR resident is responsible only for the abdominal MR exams during his/her month.
The senior MR resident should review selected MR MSK exams with attending staff in a timely fashion, and
in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same.
The senior MR resident may review selected MR CNS exams with attending staff in a timely fashion, and in
an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same.
The MR resident will be responsible to prepare 2 MR cases, on PowerPoint (in ICR format) from a provided
list, to the MR supervisor by the end of the rotation.
The MR resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where
applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
SPECIFIC DAILY DUTIES
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so
can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
Any holiday time taken during this rotation must have appropriate approval and follow the protocol outlined
in the Radiology Resident Manual.
The MR Resident will review at least 10 (total number) of Abdominal and/or MSK PF per day with the staff
designated in either of the ER PF or MR slots contained in the Work Rota. When there is no staff designated
in the ER PF slot, then the review can occur with the staff designated in the standard Plain Film slot.
146
The MR resident will check the daily MR patient list at both sites (Janeway and HSC) to ensure proper
protocols are in place and to deal with any safety/contrast questions that may arise.
The MR resident will present cases to staff in a prepared, organized fashion and subsequently dictate a
timely concise, accurate report.
A verbal report must be provided to the responsible attending physician for urgent findings that are detected;
the details of this communication must be then acknowledged subsequently at the end of the generated
report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Practical Guide to Abdominal and Pelvic MRI:
John Leyendecker, Jeffrey Brown
MSK MRI:
Clyde Helms, Nancy Major
Recommended reading list:
Body MRI : Evan Seigelman
Resource List :
MRI Normal Variants and Pitfalls:
Laura Bancroft, Mellena Bridges
1.
Medical Expert
OBJECTIVES PGY 3 :
After completing this rotation, the resident should be able to:
1. Identify and describe the basic MR anatomy of the abdomen/pelvis, Musculoskeletal and CNS
systems.
2. Articulate the basic physics of MRI.
3. Describe and identify pertinent MR safety issues.
4. Determine indications for appropriate MR examinations in relation to the specific organ system, after
reviewing pertinent background clinical information, and preceding diagnostic examinations.
5. Outline and discuss current MR imaging procedures/protocols after studying the accompanying MR
Protocol Document and content structure/suggested readings:
6. Outline and discuss indications and contraindications of Gadolinium contrast agents as well as the
following:
147
a)
Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast
media excretion.
b)
Identify patients who are at risk from injection of intravascular radiographic contrast material.
Comprehend the classification, symptoms, and signs of contrast reactions and clinical
management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
c)
i)
Consult the ACR Manual for Contrast Media.
ii)
Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
Understand the indications for premedication and the appropriate regimen to premedicate
contrast sensitive patients including dosages, and dose scheduling
7. Describe the major elements in the MR organ based medical knowledge objectives (curriculum)
specifically in the Abdominal, MSK and CNS systems.
8. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
9. Effectively communicate simple instructions to technologists and significant findings to the referring
physician staff and house staff.
10. Organize MR diagnostic imaging requests that are generated by the ordering clinicians.
OBJECTIVES PGY 5 :
After completing this rotation, the resident should be able to:
11. Demonstrate a thorough understanding of the basic MR anatomy of the abdomen/pelvis ,
Musculoskeletal and CNS systems .(PGY 5)
12. Display a sound working knowledge of the physics of MRI.
13. Describe, identify and deal with pertinent MR safety issues.
14. Determine indications for, and implement appropriate MR examinations in relation to the specific
organ system, after reviewing pertinent background clinical information, and preceding diagnostic
examinations.
15. Outline and discuss and implement current MR imaging procedures/protocols after studying the
accompanying MR Protocol Document and content structure/suggested readings:
16. Demonstrate a sound understanding of the indications and contraindications of Gadolinium contrast
agents as well as the following:
a)
Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast
media excretion.
b)
Identify patients who are at risk from injection of intravascular radiographic contrast material.
Comprehend the classification, symptoms, and signs of contrast reactions and clinical
management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
148
c)
i)
Consult the ACR Manual for Contrast Media.
ii)
Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
Understand the indications for premedication and the appropriate regimen to premedicate
contrast sensitive patients including dosages, and dose scheduling
17. Describe the major elements in the MR organ based medical knowledge objectives (curriculum)
specifically in the Abdominal, MSK and CNS systems.
18. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
19. Effectively communicate instructions to technologists and significant findings to the referring
physician staff and house staff.
20. Initiate, organize/coordinate and screen/triage MR diagnostic imaging requests that are generated by
ordering clinicians.
a)
Develop lifelong learning skills to augment knowledge of medicine and Diagnostic Radiology
(recognition of imaging abnormalities with synthesis of clinical and radiological information to
arrive at the correct diagnosis or differential diagnosis)
2.
b)
Progressive increase in radiological knowledge base and continuous learning in MR
Radiology during rotations and case based study.
c)
Acquire knowledge of principles of MR Physics
d)
Demonstrate the ability to use all relevant Resource Materials (Refer to Appendix - Core
Reference List of texts, references, websites, sources for lifelong self-learning)
e)
Knowledge of principles of research design and implementation.
f)
Demonstrates knowledge of MR imaging produces diagnostic information and their
advantages and limitations.
g)
Have film reading ability of plain film ( abdominal/MSK) examinations.
h)
Be able to recommend an appropriate MR imaging study in an emergent situation.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
Skills:
149
3.
a)
Provide an accurate clear and informative radiologic report with a precise diagnosis when
possible or a relevant differential diagnosis with recommendations for follow up or further
imaging as appropriate
b)
Directly communicate urgent and unexpected findings with the referring physician or their
representative. Document the communication in the report.
c)
Demonstrate effective face to face skills with patients and their families, other physicians,
nurses, technologists and support staff
d)
Demonstrate appropriate telephone and digital communication skills
e)
Demonstrate skills in obtained written and verbal informed consent
f)
Participate in multidisciplinary conferences and radiologic case presentations.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
150
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
Skills:
6.
a)
Gather essential and accurate information about patients
b)
Gather information from the patient folder, faculty, literature, digital textbooks and internet
c)
Develop an imaging plan based on the clinical presentation and available information
d)
Perform the appropriate examination with skill and knowledge.
f)
Demonstrate knowledge regarding the indications and contra-indications of MR imaging.
g)
Ascertain that the correct procedure is performed on the correct patient
h)
Explain the procedure and obtain consent if required.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
Identify strengths, deficiencies, and limits in their knowledge and expertise; set learning and
improvement goals; use multiple sources, including information technology to optimize life-long
learning and support patient care decisions.
Incorporate formative evaluation feedback into daily practice.
151
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
Demonstrate confidentiality with all information transmitted during a patient encounter.
Demonstrate an understanding of broad principles of biomedical ethics.
Demonstrate positive work habits including punctuality and a professional appearance.
Demonstrate knowledge of issues of impairment (i.e. physical, mental and alcohol and substance
abuse) obligations for impaired physician reporting, and resources and options for care of selfimpairment or impaired colleagues.
152
Musculoskeletal Radiology (HSC): Level I
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC MSK Objectives in Level II below)
SUPERVISOR:
Dr. John Hopkins, Health Sciences
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY2,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fillin-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the
rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies with an emphasis on plain
radiographs.
1. The minimum number of plain radiographs is 30 per day. A list of all Plain Radiographs, MR and CT
exam accession numbers of reported exams is to be submitted to Karen on a weekly basis – please
discuss an appropriate day with Karen.
2. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday &
15-20 studies on Tuesday).
3. All MSK CT exams for the week (average 1-2 per day).
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon,
but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit)
and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by
153
the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
Observe and understand Basic Radiographic Positioning: Radiography & MRI: approximately 2 Days will be
assigned with technologist.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility
of resident until their return at end of rotation.
1.
2.
3.
4.
5.
6.
7.
8.
1.
MSK Section of Brant & Helms
Arthritis in Black and White (St. Clare’s Rotation)
Musculoskeletal MRI: Chapters 1,2,10,15 (Introduction, Marrow, Shoulder, Knee)
The Requisites: Musculoskeletal Imaging: Chapters 1, 2, 29-37, 40, 41, 45, 48, 49
Orthopedic Imaging: Chapters 4-10 inclusive, 16, 29,
Arthrography: Chapter 7 (Shoulder)
Research Assigned Topics & Cases: Resnick & related journal articles
Medical Expert
Learn the musculoskeletal anatomy and the normal variations.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Demonstrate learning of normal MRI anatomy of the knee and shoulder.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Recognize and describe fractures and dislocations of the cervical, thoracic and lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of
healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic
arthritis.
154
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Recognize and evaluate imaging studies which demonstrate arthopathies including: rheumatoid
arthritis, psoriatic arthritis, crystalline arthropathies, osteoarthritis, sero-negative
spondyloarthropathies, scleroderma as well as other connective tissue diseases, vasculitic conditions
including systemic lupus.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Fibrous dysplasia
Eosinophilic granuloma
Giant cell tumor
Non ossifying fibroma
Osteoid osteoma
Multiple myeloma
Metastatic disease
Aneurysmal bone cyst
Solitary bone cyst
Enchondroma
Ewing’s sarcoma
Chordoma
Pigmented villonodular synovitis
Chondroblastoma
Osteogenic sarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Malignant fibrous histiocytoma
Osteoblastoma
Hemangiomas
Osteochondroma (s)
Nerve sheath tumors
Adamantinoma
Recognize features of MSK infection on various imaging studies including:
•
•
•
•
•
•
•
•
Osteomyelitis
Septic arthritis
Cellulites
Myositis
Tenosynovitis
Abscess Formation
Discitis
Gangrene
155
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
•
•
•
•
•
•
•
Renal osteodystrophy
Rickets
Scurvy
Paget’s disease
Avascular necrosis/infarct
Neuropathic joint
Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on knee and shoulder).
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
knee and shoulder. The resident should have good understanding of at least the following:
•
•
•
•
•
•
•
•
•
ACL tear
Meniscal injury
MCL tear
Lateral complex injury
Postero-lateral corner injury
Quadriceps/patellar tendon tear
OCD
Rotator cuff tear
Shoulder labral tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
•
•
•
•
•
•
•
•
Mono/poly arthropathies
Lytic/radiolucent bony lesion (s)
Sclerotic bony lesion (s)
Osteopenia
Sacroillitis
Periosteal reaction
Soft tissue calcification
Soft tissue mass
156
Musculoskeletal Radiology (HSC): Level II
SUPERVISOR:
Dr. John Hopkins, Health Sciences
The following is an outline of both the curriculum as well as the goals and objectives of the Musculoskeletal
rotation during PGY 4, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fillin-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the
rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies.
4. The minimum number of plain radiographs is 40 per day. A list of all exam accession numbers of
reported exams is to be submitted to Karen on a weekly basis.
5. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday &
15-20 studies on Tuesday).
6. All MSK CT exams for the week (average 1-2 per day).
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform with formal guidance and gain increased understanding and proficiency in MSK interventional
procedures such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for
Tuesday afternoon, but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday
(Room 10, MR Unit) and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by
the end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
157
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first
rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility
of resident until their return at end of rotation.
9. Review Arthritis in Black and White
10. Musculoskeletal MRI: Infection, Tumor, Hip, Wrist & Review Chapters Shoulder, Knee, Infection,
Tumor)
11. The Requisites: Musculoskeletal Imaging: Chapters 16-28, 50
12. Orthopedic Imaging: Chapters 17-23, 24-28
13. Research Assigned Topics & Cases: Resnick & related journal articles
1.
Medical Expert
Learn the musculoskeletal anatomy and the normal variations.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Review and consolidate knowledge of normal MRI anatomy of the knee and shoulder.
Demonstrate learning of normal MRI anatomy of the hip and wrist.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar
spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of
healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic
arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
158
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate
salient radiologic (radiographic, CT and MR) features of common arthropathies including
osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, sernegative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition,
gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus
erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial
chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive & non-aggressive lesions and be able to recognize them on imaging
studies. Should know radiology, pathology, presentation and management of at least the following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Fibrous dysplasia
Eosinophilic granuloma
Giant cell tumor
Non ossifying fibroma
Osteoid osteoma
Multiple myeloma
Metastatic disease
Aneurysmal bone cyst
Solitary bone cyst
Enchondroma
Ewing’s sarcoma
Chordoma
Pigmented villonodular synovitis
Chondroblastoma
Osteogenic sarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Malignant fibrous histiocytoma
Osteoblastoma
Hemangiomas
Osteochondroma (s)
Nerve sheath tumors
Adamantinoma
Recognize features of MSK infection on various imaging studies including:
• Osteomyelitis
• Septic arthritis
• Cellulitis
• Myositis
• Tenosynovitis
• Abscess Formation
159
•
•
Discitis
Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
•
•
•
•
•
•
•
Renal osteodystrophy
Rickets
Scurvy
Paget’s disease
Avascular necrosis/infarct
Neuropathic joint
Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on hip and wrist)
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
hip and wrist. The resident should have good understanding of at least the following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
ACL tear
Meniscal injury
MCL tear
Lateral complex injury
Postero-lateral corner injury
Quadriceps/patellar tendon tear
Knee OCD
Rotator cuff tear
Biceps tendon rupture (proximal and distal)
Shoulder and hip labral tear
Hip AVN
Transient osteoporosis
Hip Fracture
Femoroacetabular Impingement
Kienbock’s
TFCC Tear
Tenosynovitis
Scapholunate/lunotriquetral ligament tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
•
Mono/poly arthropathies
160
•
•
•
•
•
•
•
2.
Lytic/radiolucent bony lesion (s)
Sclerotic bony lesion (s)
Osteopenia
Sacroillitis
Periosteal reaction
Soft tissue calcification
Soft tissue mass
Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
161
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
162
Musculoskeletal Radiology (HSC): Level III
SUPERVISOR:
Dr. John Hopkins, Health Sciences
The following is an outline of both the curriculum as well as the goals and objectives of the Musculoskeletal
rotation during PGY 5, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fillin-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the
rotation incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
Become a near- independent provider of musculoskeletal interpretative services.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies.
1. The minimum number of plain radiographs is 50 per day. A list of exam accession numbers of reported
exams is to be submitted to Karen/Margie at end of each day.
2. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday &
15-20 studies on Tuesday).
3. All MSK CT exams for the week (average 1-2 per day).
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform independently and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon,
but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit)
and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by
the end of the rotation.
163
Present 1 MSK case each Tuesday at ICR during your rotation.
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first and
second rotations.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility
of resident until their return at end of rotation.
14. Musculoskeletal MRI: Chapters Elbow, Ankle & Foot & Review Shoulder, Knee
15. The Requisites: Musculoskeletal Imaging: Chapters 38, 42-47
16. Research Assigned Topics & Cases: Resnick & related journal articles
1.
Medical Expert
Learn the musculoskeletal anatomy and the normal variations.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
Review and consolidate knowledge of normal MRI anatomy of the knee, shoulder, hip and wrist.
Demonstrate learning of normal MRI anatomy of the elbow, ankle and foot.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar
spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of
healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic
arthritis.
164
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate
salient radiologic (radiographic, CT and MR) features of common arthropathies including
osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, sernegative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition,
gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus
erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial
chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Fibrous dysplasia
Eosinophilic granuloma
Giant cell tumor
Non ossifying fibroma
Osteoid osteoma
Multiple myeloma
Metastatic disease
Aneurysmal bone cyst
Solitary bone cyst
Enchondroma
Ewing’s sarcoma
Chordoma
Pigmented villonodular synovitis
Chondroblastoma
Osteogenic sarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Malignant fibrous histiocytoma
Osteoblastoma
Hemangiomas
Osteochondroma (s)
Nerve sheath tumors
Adamantinoma
Recognize features of MSK infection on various imaging studies including:
•
Osteomyelitis
165
•
•
•
•
•
•
•
Septic arthritis
Cellulitis
Myositis
Tenosynovitis
Abscess Formation
Discitis
Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
•
•
•
•
•
•
•
Renal osteodystrophy
Rickets
Scurvy
Paget’s disease
Avascular necrosis/infarct
Neuropathic joint
Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Recognize radiologic findings and describe pathophysiology of endocrine disease including
hyperparathyroidism, renal osteodystrophy, osteomalacia/rickets, hypophosphatasia,
shypophosphatemia.
Recognize radiologic findings of hematopoietic and storage diseases including sickle cell anemia,
thalassemia, mastocytosis, and Gaucher’s disease.
Demonstrate systematic approach to relatively common dysplasias and congenital conditions such
as achondroplasia, osteogenesis imperfecta, osteopetrosis
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on elbow, ankle and foot)
Recognize and describe imaging features of internal derangements of joints with emphasis upon
elbow, ankle and foot, and thorough review of knee, shoulder, hip and wrist. The resident should
have good understanding of at least the following:
•
•
•
•
•
•
ACL tear
Meniscal injury
MCL tear
Lateral complex injury
Postero-lateral corner injury
Quadriceps/patellar tendon tear
166
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Knee OCD
Rotator cuff tear
Biceps tendon rupture (proximal and distal)
Shoulder and hip labral tear
Hip AVN
Transient Osteoporosis
Hip fracture
Femoroacetabular impingement
Transient osteoporosis
Kienbock’s
TFCC Tear
Tenosynovitis
Scapholunate/lunotriquetral ligament tear
Achilles tendon rupture
Medial, lateral and anterior ankle tendon injury
Ankle ligament tears
Tarsal tunnel syndrome
Sinus tarsi syndrome
Tarsal/carpal coalition
Talar OCD/osteochondral injury and AVN
Morton’s neuroma
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
•
•
•
•
•
•
•
•
2.
Mono/poly arthropathies
Lytic/radiolucent bony lesion (s)
Sclerotic bony lesion (s)
Osteopenia
Sacroillitis
Periosteal reaction
Soft tissue calcification
Soft tissue mass
Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
167
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
168
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
169
Musculoskeletal Radiology (SCM): Level I
SUPERVISOR:
Dr. Eric Pike, St. Clare’s
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY2,
incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience and
would appreciate that any problems arising prior to, during or after your rotation be brought directly to my
attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula will be given
within the last week and will assess the acquisition of knowledge throughout the rotation. The exam
questions are derived from the rotation objectives, and consist of fill-in-the-blank and OSCE type format. A
pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be
completed at a later date.
DUTIES AND RESPONSIBILITIES
The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and
procedures related to the musculoskeletal system. During each 4 week rotation the resident should:
1. Concentrate first and foremost on seeing as many plain radiographs related to MSK imaging. This
should include daily films from the Emergency Department, Orthopedic Clinics and Out Patient
areas.
2. Check each day for interventional procedures that are booked including arthrograms and biopsies,
as well as joint injections and aspirations.
3. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases
performed using these modalities should be forwarded to you. Effort should be made to be present
for ultrasound studies particularly involving the shoulder and other tendons.
4. Review MRI cases performed under St. Clare’s. These studies are generally performed on
Wednesday evening and during the day/evening on Thursday. The resident can coordinate when the
cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if
desired but this is not mandatory. The Junior Resident should concentrate on the common exams of
the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload
for the week can be up to 25 cases.
5. At the end of your rotation, we are going to be administering a short oral exam of approximately 10
cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching
sessions on various MSK topics.
You are required to learn the anatomy, physiology and associated pathological conditions affecting the
musculoskeletal system and to be able to interpret and report associated imaging studies with an emphasis
on plain radiographs.
1. The minimum number of plain radiographs is 30 per day. A list of exam accession numbers of
reported exams is to be submitted to Karen weekly – please discuss an appropriate day with Karen.
2. All adult MR examinations for the week performed on Wednesday, Thursday and Friday.
3. All MSK CT exams for the week (average 1-2 per day).
170
4.
All risk Ultrasound exams (average 10 – 15 per week)
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the
end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
Observe and understand Basic Radiographic Positioning: Radiography & MRI: approximately 2 Days will be
assigned with technologist.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
Textbooks will be provided; assigned to the resident at the beginning of rotation and are the
responsibility of the resident until their return at the end of the rotation.
17. MSK Section of Brant & Helms
18. Arthritis in Black and White (St. Clare’s Rotation)
19. Musculoskeletal MRI: Chapters 1,2,10,15 (Introduction, Marrow, Shoulder, Knee)
20. The Requisites: Musculoskeletal Imaging: Chapters 1, 2, 29-37, 40, 41, 45, 48, 49
21. Orthopedic Imaging: Chapters 4-10 inclusive, 16, 29,
22. Arthrography: Chapter 7 (Shoulder)
23. Research Assigned Topics & Cases: Resnick & related journal articles
24. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005
25. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier
2009
171
26. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition)
27. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004
28. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004
29. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006
30. Musculoskeletal Imaging: A Teaching File, F. Chew, 2nd Edition, 2005
1.
Medical Expert
Learn the musculoskeletal anatomy and the normal variations.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Demonstrate learning of normal MRI anatomy of the knee and shoulder.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Recognize and describe fractures and dislocations of the cervical, thoracic and lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of
healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic
arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Recognize and evaluate imaging studies which demonstrate arthopathies including: rheumatoid
arthritis, psoriatic arthritis, crystalline arthropathies, osteoarthritis, sero-negative
spondyloarthropathies, scleroderma as well as other connective tissue diseases, vasculitic conditions
including systemic lupus.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
•
•
•
•
•
•
•
•
•
•
Fibrous dysplasia
Eosinophilic granuloma
Giant cell tumor
Non ossifying fibroma
Osteoid osteoma
Multiple myeloma
Metastatic disease
Aneurysmal bone cyst
Solitary bone cyst
Enchondroma
172
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ewing’s sarcoma
Chordoma
Pigmented villonodular synovitis
Chondroblastoma
Chondrosarcoma
Osteogenic sarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Malignant fibrous histiocytoma
Osteoblastoma
Hemangiomas
Osteochondroma (s)
Nerve sheath tumors
Adamantinoma
Recognize features of MSK infection on various imaging studies including:
•
•
•
•
•
•
•
•
Osteomyelitis
Septic arthritis
Cellulitis
Myositis
Tenosynovitis
Abscess Formation
Discitis
Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
•
•
•
•
•
•
•
Renal osteodystrophy
Rickets
Scurvy
Paget’s disease
Avascular necrosis/infarct
Neuropathic joint
Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on knee and shoulder).
173
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
knee and shoulder. The resident should have good understanding of at least the following:
•
•
•
•
•
•
•
•
•
ACL tear and PCL tear
Meniscal injury
MCL tear
Lateral complex injury
Postero-lateral corner injury
Quadriceps/patellar tendon tear
OCD
Rotator cuff tear
Shoulder labral tear and Variants (Spectrum of labral injury)
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
•
•
•
•
•
•
•
•
2.
Mono/poly arthropathies
Lytic/radiolucent bony lesion(s)
Sclerotic bony lesion(s)
Osteopenia
Sacroillitis
Periosteal reaction
Soft tissue calcification
Soft tissue mass
Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family.
Provide clear and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
174
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
175
Identify potential research project with supervisors.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
176
Musculoskeletal Radiology: Level II
SUPERVISOR:
Dr. Eric Pike, St. Clare’s
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY 4,
incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience. I
would appreciate that any problems arising prior to, during or after your rotation be brought directly to my
attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula will be given
within the last week and will assess the acquisition of knowledge throughout the rotation. The exam
questions are derived from the rotation objectives, and consist of fill-in-the-blank, and OSCE type format. A
pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be
completed at a later date.
DUTIES AND RESPONSIBILITIES
The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and
procedures related to the musculoskeletal system. During each 4 week rotation the resident should:
6. Concentrate first and foremost on seeing as many plain radiographs related to MSK imaging. This
should include daily films from the Emergency Department, Orthopedic Clinics and Out Patient
areas.
7. Check each day for interventional procedures that are booked including arthrograms, biopsies as
well as joint injections and aspirations.
8. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases
performed using these modalities should be forwarded to you. Effort should be made to be present
for ultrasound studies particularly involving the shoulder and other tendons.
9. Review MRI cases performed under St. Clare’s each week. These studies are generally performed
on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when
the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if
desired but this is not mandatory. The Junior Resident should concentrate on the common exams of
the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload
for the week can be up to 25 cases. The more experienced Senior Resident should take on a heavier
caseload.
10. At the end of your rotation, we are going to be administering a short oral exam of approximately 10
cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching
sessions on various MSK topics.
You are required to learn the anatomy, physiology and associated pathological conditions affecting the
musculoskeletal system and to be able to interpret and report associated imaging studies.
7. The minimum number of plain radiographs is 40 per day. A list of exam accession numbers of
177
reported exams is to be submitted to Karen weekly – please discuss an appropriate day with Karen.
8. All adult MR examinations for the week performed on Wednesday, Thursday and Friday.
9. All MSK CT exams for the week (average 1-2 per day).
10. All risk Ultrasound exams (average 10 – 15 per week)
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform with formal guidance and gain increased understanding and proficiency in MSK interventional
procedures such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the
end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first
rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
Textbooks will be provided; assigned to the resident at beginning of the rotation and are the
responsibility of the resident until their return at the end of rotation.
31. Review Arthritis in Black and White
32. Musculoskeletal MRI: Infection, Tumor, Hip, Wrist & Review Chapters Shoulder, Knee, Infection,
Tumor)
33. The Requisites: Musculoskeletal Imaging: Chapters 16-28, 50
34. Orthopedic Imaging: Chapters 17-23, 24-28
178
35. Research Assigned Topics & Cases: Resnick & related journal articles
36. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005
37. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier
2009
38. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition)
39. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004
40. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004
41. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006
42. Musculoskeletal Imaging: A Teaching File, F Chew, 2nd Edition, 2005
1.
Medical Expert
Learn the musculoskeletal anatomy and the normal variations.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Review and consolidate knowledge of normal MRI anatomy of the knee and shoulder.
Demonstrate learning of normal MRI anatomy of the hip and wrist.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar
spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of
healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic
arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate
salient radiologic (radiographic, CT and MR) features of common arthropathies including
osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, sernegative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition,
gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus
erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial
chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
179
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Fibrous dysplasia
Eosinophilic granuloma
Giant cell tumor
Non ossifying fibroma
Osteoid osteoma
Multiple myeloma
Metastatic disease
Aneurysmal bone cyst
Solitary bone cyst
Enchondroma
Ewing’s sarcoma
Chordoma
Pigmented villonodular synovitis
Chondroblastoma
Chondrosarcoma
Osteogenic sarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Malignant fibrous histiocytoma
Osteoblastoma
Hemangiomas
Osteochondroma (s)
Nerve sheath tumors
Adamantinoma
Recognize features of MSK infection on various imaging studies including:
•
•
•
•
•
•
•
•
Osteomyelitis
Septic arthritis
Cellulitis
Myositis
Tenosynovitis
Abscess Formation
Discitis
Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
180
•
•
•
•
•
•
•
Renal osteodystrophy
Rickets
Scurvy
Paget’s disease
Avascular necrosis/infarct
Neuropathic joint
Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on hip and wrist).
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
hip and wrist. The resident should have good understanding of at least the following:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
ACL tear and PCL tear
Meniscal injury
MCL tear
Lateral complex injury
Postero-lateral corner injury
Quadriceps/patellar tendon tear
Knee OCD
Rotator cuff tear
Biceps tendon rupture (proximal and distal)
Shoulder and hip labral tear
Hip AVN
Transient osteoporosis
Hip Fracture
Femoroacetabular Impingement
Kienbock’s
TFCC Tear
Tenosynovitis
Scapholunate/lunotriquetral ligament tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
•
•
•
•
•
•
•
•
2.
Mono/poly arthropathies
Lytic/radiolucent bony lesion (s)
Sclerotic bony lesion (s)
Osteopenia
Sacroillitis
Periosteal reaction
Soft tissue calcification
Soft tissue mass
Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
181
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
182
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
183
Musculoskeletal Radiology (SCM): Level III
SUPERVISOR:
Dr. Eric Pike, St. Clare’s
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY 5,
incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience. I
would appreciate that any problems arising prior to, during or after your rotation be brought directly to my
attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of fill-in-the-blank,
and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation
incomplete, and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and
procedures related to the musculoskeletal system. During each 4 week rotation the resident should:
11. Concentrate first & foremost on seeing as many plain radiographs related to MSK imaging. This
should include daily films from the Emergency Department, Orthopedic Clinics & Out Patient areas.
12. Check each day for interventional procedures that are booked including arthrograms, biopsies as
well as joint injections and aspirations.
13. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases
performed using these modalities should be forwarded to you. Effort should be made to be present
for ultrasound studies particularly involving the shoulder and other tendons.
14. Review MRI cases performed under St. Clare’s each week. These studies are generally performed
on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when
the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if
desired but this is not mandatory. The Junior Resident should concentrate on the common exams of
the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload
for the week can be up to 25 cases. The more experienced Senior Resident should take on a heavier
caseload.
15. At the end of your rotation, we are going to be administering a short oral exam of approximately 10
cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching
sessions on various MSK topics.
Become a near- independent provider of musculoskeletal interpretative services.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies.
11. The minimum number of plain radiographs is 50 per day. A list of exam accession numbers of
reported exams is to be submitted to Karen weekly - please discuss an appropriate day with Karen.
12. All adult MR examinations for the week performed on Wednesday, Thursday and Friday.
13. All MSK CT exams for the week (average 1-2 per day).
14. All risk Ultrasound exams (average 10 – 15 per week)
184
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
To supervise MSK rounds when scheduled.
Attend Orthopedic Trauma Rounds Tuesday @ 7:30 AM.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Participate in the education of medical students, interns and residents.
Perform independently and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the
end of the rotation.
Present 1 MSK case each Tuesday at ICR during your rotation.
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first and
second rotations.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
Textbooks will be provided; assigned to the resident at the beginning of the rotation and are the
responsibility of the resident until their return at the end of rotation.
43. Musculoskeletal MRI: Chapters Elbow, Ankle & Foot & Review Shoulder, Knee
44. The Requisites: Musculoskeletal Imaging: Chapters 38, 42-47
45. Research Assigned Topics & Cases: Resnick & related journal articles
46. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005
47. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier
2009
48. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition)
49. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004
50. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004
51. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006
185
52. Musculoskeletal Imaging: A Teaching File, F Chew, 2nd Edition, 2005
1.
Medical Expert
Learn the musculoskeletal anatomy and the normal variations.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
Review and consolidate knowledge of normal MRI anatomy of the knee, shoulder, hip and wrist.
Demonstrate learning of normal MRI anatomy of the elbow, ankle and foot.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition & description of fractures & dislocations of the cervical, thoracic & lumbar spine.
Demonstrate learning of pathophysiology and radiology of fracture healing and complications of
healing such as delayed union, malunion and nonunion.
Demonstrate learning of radiographic presentation & evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe & differentiate salient
radiologic (radiographic, CT and MR) features of common arthropathies including osteoarthritis,
inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-negative
spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition, gout,
hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus
erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, & synovial
chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue & bone tumors. The resident should
know the features of aggressive & non-aggressive lesions and be able to recognize them on imaging
studies. Should know radiology, pathology, presentation and management of at least the following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
186
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Multiple myeloma
Metastatic disease
Aneurysmal bone cyst
Solitary bone cyst
Enchondroma
Ewing’s sarcoma
Chordoma
Pigmented villonodular synovitis
Chondroblastoma
Chondrosarcoma
Osteogenic sarcoma
Fibrosarcoma
Liposarcoma
Leiomyosarcoma
Malignant fibrous histiocytoma
Osteoblastoma
Hemangiomas
Osteochondroma (s)
Nerve sheath tumors
Adamantinoma
Recognize features of MSK infection on various imaging studies including:
• Osteomyelitis
• Septic arthritis
• Cellulitis
• Myositis
• Tenosynovitis
• Abscess Formation
• Discitis
• Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
187
Recognize radiologic findings and describe pathophysiology of endocrine disease including
hyperparathyroidism, renal osteodystrophy, osteomalacia/rickets, hypophosphatasia,
shypophosphatemia.
Recognize radiologic findings of hematopoietic and storage diseases including sickle cell anemia,
thalassemia, mastocytosis, and Gaucher’s disease.
Demonstrate systematic approach to relatively common dysplasias and congenital conditions such
as achondroplasia, osteogenesis imperfecta, osteopetrosis
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on elbow, ankle and foot)
Recognize and describe imaging features of internal derangements of joints with emphasis upon
elbow, ankle and foot, and thorough review of knee, shoulder, hip and wrist. The resident should
have good understanding of at least the following:
• ACL tear and PLC tear
• Meniscal injury
• MCL tear
• Lateral complex injury
• Postero-lateral corner injury
• Quadriceps/patellar tendon tear
• Knee OCD
• Rotator cuff tear
• Biceps tendon rupture (proximal and distal)
• Shoulder and hip labral tear plus variants (spectrum of labral injury)
• Hip AVN
• Transient Osteoporosis
• Hip fracture
• Femoroacetabular impingement
• Transient osteoporosis
• Kienbock’s
• TFCC Tear
• Tenosynovitis
• Scapholunate/lunotriquetral ligament tear
• Achilles tendon rupture
• Medial, lateral and anterior ankle tendon injury
• Ankle ligament tears
• Tarsal tunnel syndrome
• Sinus tarsi syndrome
• Tarsal/carpal coalition
• Talar OCD/osteochondral injury and AVN
• Morton’s neuroma
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
• Lytic/radiolucent bony lesion (s)
• Sclerotic bony lesion (s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
188
•
•
2.
Soft tissue calcification
Soft tissue mass
Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
189
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
190
Neuroradiology: Level I (PGY2)
SUPERVISOR:
Dr. Peter Bartlett, Health Sciences
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY2,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The
exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and
OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous
system and to be able to interpret and report associated imaging studies with an emphasis on Computed
Tomography.
Review and report all CT scans of head and spine performed at HSC site.
Where time allows, review some MRI studies to become familiar with this modality in preparation for the
PGY3 rotation.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures
such as lumbar puncture.
Review CT protocols for your CT list each day.
Submit (in power point format) 4 researched & prepared CNS cases as assigned by the end of the rotation.
Present 1 CNS case each Tuesday at ICR during your rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
191
REQUIRED READING LIST
1. Neuroradiology: Anne Osborne
2. Statdx: Appropriate sections.
1.
Medical Expert
Know the gross anatomy of the central nervous system and review the pertinent aspects of functional
neuroanatomy.
Become exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow,
the resident should strive to obtain proficiency in these examinations.
Become familiar with the basic imaging sequences required in MRI scanning of the head and spine.
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Know the anatomy and pathology regarding the brain and spinal cord.
Be able to read the following films: CT, MRI and myelogram.
Perform myelogram/lumbar punctures.
Be able to protocol MRI/CT scan examinations.
Specific Learning Objectives:
Normal Variants: Brain: Aging Brain, Arachnoid Granulations, Cavum Septi Pellucidi (CSP), Cavum
Velum Interpositum (CVI), Enlarged Perivascular Spaces. Spine: Conjoined Nerve Roots Spine, Incomplete
Fusion of Posterior Element Spine, Limbus Vertebra Spine.
Congenital/Genetic in the Adult: Brain Aqueductal Stenosis, Chiari Malformation, Dandy Walker
Continuum, Lipoma. Spine: Scheuermann Disease, Schmorl Node, Vertebral Segmentation Failure
Trauma: Brain Brain Death, Calvarium Fracture, Cerebral Contusion, Cerebral Edema, Diffuse Axonal
Injury (DAI), Epidural Hematoma, Herniation Syndromes, Missile and Penetrating Injury, Pneumocephalus,
Subarachnoid Hemorrhage, Subdural Hematoma. Spine: Plain radiograph and CT of spinal trauma is
covered in MSK, but reinforced in Neuroradiology.
Vascular Disease: Arteriolosclerosis, Carotid Cavernous Fistula, Cerebral Infarction, Cerebral Venous
Sinus Thrombosis, Hypertensive Hemorrhage, Small Vessel Ischemia, Spontaneous Intracranial
Hemorrhage, Aneurysmal Subarachnoid Hemorrhage, Nonaneurysmal Perimesencephalic SAH
Vascular Disease, Malformations: Arteriovenous Malformation, Cavernous Malformation Brain,
Developmental Venous Anomaly (DVA)
Infection: Brain: Abscess, Extra-Axial Empyema, Herpes Encephalitis, Meningitis. Spine: Epidural
abscess.
Metabolic: Acute Hypertensive Encephalopathy (PRES), Hepatic Encephalopathy, Hypoglycemia, Osmotic
Demyelination Syndrome
192
Degenerative: Brain: Alzheimer Dementia, Multi-Infarct Dementia, Normal Pressure Hydrocephalus,
Obstructive Hydrocephalus, Porencephalic Cyst. Spine: Acquired Lumbar Canal Stenosis, Cervical Facet
Arthropathy, Degenerative Disc Disease, Degenerative Endplate Changes, Disc Herniation, DISH,
Spondylolisthesis, Spondylolysis, Synovial Cyst,
Toxic: Alcoholic Encephalopathy, CO Poisoning, Drug Abuse, Idiopathic Intracranial Hypertension,
Neoplasm, Benign: Brain Hemangioblastoma, Meningioma, Neurofibroma, Pilocytic Astrocytoma, Pituitary
Adenoma, Schwannoma. Spine: Hemangioma,
Neoplasm, Malignant: Brain: Metastases: Astrocytoma, Low Grade, Glioblastoma Multiforme, Primary
CNS Lymphoma, Oligodendroglioma. Spine: Metastatic Lesions, Multiple Myeloma,
Cysts, Non-neoplastic: Brain: Arachnoid Cyst, Colloid Cyst, Dermoid Cyst, Epidermoid Cyst. Pineal Cyst.
Spine: Perineural Root Sleeve Cyst,
Treatment-Related Lesions: CSF Shunts and Complications
Idiopathic/Miscellaneous: Empty Sella, Paget Disease, Thick Skull
2.
Communicator
Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call
and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
193
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
194
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
195
Insert Mario’s Neuro/ENT Objectives here
Neuroradiology: 2 months – Level II (PGY-3)
SUPERVISOR:
Dr. Peter Bartlett, Health Sciences
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY3,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The
exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and
OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous
system and to be able to interpret and report associated imaging studies with an emphasis on Magnetic
Resonance Imaging.
Review and report all MRI scans of head and spine performed at HSC site.
Where time allows, review some MRI studies from the Janeway site and/or CT from the HSC site.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures
such as lumbar puncture.
Review MRI protocols for your list each day.
Submit (in powerpoint format) 4 researched & prepared CNS cases as assigned to you by the end of the
rotation.
Present 1 CNS case each Tuesday at ICR during your rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
196
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
1. Neuroradiology: Anne Osborne
2. Statdx: Appropriate sections.
1.
Medical Expert
Know the gross anatomy of the central nervous system and to review the pertinent aspects of
functional neuroanatomy.
To be proficient in the interpretation of imaging studies in the evaluation of patients with neurological
and neurosurgical diseases.
To be exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow,
the resident should strive to obtain proficiency in these examinations.
To be familiar with the basic and advanced imaging sequences required in MRI scanning of the head
and spine. (Diffusion imaging)
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Know the anatomy and pathology regarding the brain and spinal cord.
Be able to read the following films: CT, MRI and myelogram.
Perform myelogram/lumbar punctures.
Be able to protocol MRI/CT scan examinations.
Specific Learning Objectives:
All of the objectives in the PGY2 rotation, plus:
Congenital/Genetic in the Adult:Brain Callosal Dysgenesis, Frontoethmoidal Cephalocele, Coloboma,
Congenital Vermian Hypoplasia, Heterotopic Gray Matter, Dehiscent Jugular Bulb, PachygyriaPolymicrogyria, Persistent Trigeminal Artery, Pituitary Stalk Anomalies, Schizencephaly, Tuber Cinereum
Hamartoma Spine: Anterior Sacral Meningocele, Connective Tissue Disorders, Diastematomyelia, KlippelFeil Spectrum, Myelomeningocele, Neurenteric Cyst,
Tethered Spinal Cord, Ventriculus Terminalis.
Congenital/Genetic, Neurocutaneous Syndromes: HHT, Neurofibromatosis 1, Neurofibromatosis 2,
Sturge-Weber Syndrome, Tuberous Sclerosis Complex, von Hippel Lindau
197
Trauma: Brain CSF Leak, Diffuse Axonal Injury (DAI), Extracranial Dissection, Intracranial Dissection,
Intracranial Hypotension Spine: Central Spinal Cord Syndrome, Contusion-Hematoma, Post-Traumatic
Syrinx,
Vascular Disease: CADASIL, Carotid Cavernous Fistula, Cerebral Amyloid Disease, Cerebral IschemiaInfarction/ Diffusion Imaging, Dural A-V Fistula, Hypertensive Encephalopathy, Hypotensive Cerebral
Infarction, Moyamoya, Persistent Trigeminal Artery, Primary Arteritis of the CNS, Vascular Loop Syndrome
(CPA-IAC), Vasculitis, Vertebrobasilar Insufficiency. Spine: Spinal Cord Infarction,
Vascular Disease, Aneurysms: Fusiform Aneurysm, Pseudoaneurysm, Saccular Aneurysm, Superficial
Siderosis
Vascular Disease, Malformations: Capillary Telangiectasia, Dural A-V Fistula, Vein of Galen Malformation
Infection: Brain: AOM with Complication, Apical Petrositis, Encephalitis, Fungal Diseases, Fungal Sinusitis,
HIV Encephalitis, Lyme Disease, Neurocysticercosis, Opportunistic Infection, AIDS, Tuberculosis,
Ventriculitis Spine: Epidural abscess, Viral Myelitis, Osteomyelitis/discitis.
Inflammation: Brain:ADEM, Cerebral Amyloid Angiopathy, Lymphocytic Hypophysitis, Mucocele, Multiple
Sclerosis, Neurosarcoid, Optic Neuritis, Sinonasal Polyposis, Pseudotumor, Radiation Vasculopathy,
Ramsay Hunt Syndrome, Sarcoidosis, Subacute Sclerosing Panencephalitis. Spine: Acute Transverse
Myelopathy, Guillain-Barre Syndrome, Hypertrophic Neuropathy, Lumbar Arachnoiditis,
Metabolic: Canavan Disease, Fahr Disease, Huntington Disease, Krabbe, Leigh Syndrome, MELAS,
Metachromatic Leukodystrophy (MLD), Paraneoplastic Disorders, Wilson Disease
X-Linked Adrenoleukodystrophy
Degenerative: Brain: Amyotrophic Lateral Sclerosis (ALS), Hypertrophic Olivary Degeneration,
Frontotemporal Dementia, Hypertrophic Olivary Degeneration, Creutzfeldt-Jakob Disease (CJD)
Mesial Temporal Sclerosis, Multiple System Atrophy, Parkinson Disease, Pituitary Apoplexy
Wallerian Degeneration. Spine: Anular Tear, OPLL Spine, Ossification Ligamentum Flavum,
Toxic: Radiation and Chemotherapy, Status Epilepticus
Neoplasm, Benign: Brain Central Neurocytoma, Chordoma, Choroid Plexus Papilloma,
Craniopharyngioma, DNET, Endolymphatic Sac Tumor, Ganglioglioma,
Glomus Tumor (Paraganglioma), Hemangioblastoma, Osteoma, Pineocytoma,Subependymal Giant Cell
Astrocytoma, Subependymoma. Spine: Angiolipoma, Chordoma, Hemangioblastoma, Meningioma,
Neurofibroma, Paraganglioma, Schwannoma
Neoplasm, Malignant: Brain: Anaplastic Astrocytoma, Chondrosarcoma, Choroid Plexus Carcinoma,
Ependymoma, Esthesioneuroblastoma, Optic Glioma, Gliomatosis Cerebri, Hemangiopericytoma,
Medulloblastoma (PNET-MB), Ocular Melanoma, Nasopharyngeal Carcinoma, Pineoblastoma, Sinonasal
SCCa, Supratentorial PNET, Teratoma Spine: Astrocytoma, Ependymoma, Leukemia, Lymphoma,
Metastatic.
Tumor-like Lesions: Fibrous Dysplasia, Idiopathic Orbital Inflammatory Disease (Pseudotumor),
Langerhans Histiocytosis, Paget Disease
Cysts, Non-neoplastic: Brain: Choroid Plexus Cyst, Ependymal Cyst, Neurenteric Cyst, Neuroglial Cyst,
Rathke Cleft Cyst Spine: Syrinx, Arachnoid Cyst
198
Treatment-Related Lesions: CSF Leak, Failed Back Surgery Syndrome, Hardware Failure.
Idiopathic/Miscellaneous: Migraine, Osteopetrosis,
2.
Communicator
Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call
and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
199
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
200
Neuroradiology: 2 months – Level III (PGY-5)
SUPERVISOR:
Dr. Peter Bartlett, Health Sciences
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY5,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The
exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and
OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date.
DUTIES AND RESPONSIBILITIES
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous
system and to be able to interpret and report associated imaging studies with an emphasis on both CT and
Magnetic Resonance Imaging.
Review and report all MRI scans of head and spine performed at HSC site.
Where time allows, review some MRI studies from the Janeway site and or CT from the HSC site.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures
such as lumbar puncture.
Review CT and MRI protocols for your list each day.
Submit (in powerpoint format) 4 researched & prepared CNS cases as assigned to you by the end of the
rotation.
Present 1 CNS case each Tuesday at ICR during your rotation.
Generate accurate and concise radiographic reports.
201
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
REQUIRED READING LIST
1. Neuroradiology: Anne Osborne
2. Statdx: Appropriate sections.
1.
Medical Expert
To know the gross anatomy of the central nervous system and to review the pertinent
aspects of functional neuroanatomy.
To be proficient in the interpretation of imaging studies in the evaluation of patients with
neurological and neurosurgical diseases.
To be exposed to the techniques of myelography and lumbar puncture. If numbers of cases
allow, the resident should strive to obtain proficiency in these examinations.
To be familiar with the basic and advanced imaging sequences required in MRI scanning of
the head and spine. (Diffusion imaging)
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast.
Specific Learning Objectives:
Review all of the objectives in the PGY2 and PGY3 rotations. Elaborate on differential diagnosis with
reference to the specific case rather than repeating a standard list. The resident should be able to
function as a consultant by the end of this rotation.
2.
Communicator
Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call
and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
202
3.
Collaborator
Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
203
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
204
Nuclear Medicine: PGY3 & PGY5
SUPERVISOR:
Dr. Peter Hollett, Health Sciences Center
SUPERVISOR:
Dr. Cheryl Jefford, St. Clare’s
Should we say something about the movement between sites.
The following is an outline of the goals and objectives of the Nuclear Medicine rotation during PGY3 and
PGY5, incorporated into CanMEDS format. The CanMEDS roles will be assessed and remain consistent
throughout the Nuclear Medicine rotations as a PGY3 and PGY5, with the expectation that skills will be
further developed as a PGY5.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will
be completed at a later date.
DUTIES AND RESPONSIBILITIES
Be aware of the complementary role that Nuclear Medicine provides in the overall imaging of patients with
illness.
Understand the role of functional imaging as opposed to anatomical imaging.
Have an appreciation of the range of functional studies available within Nuclear Medicine.
Review and supervise all on-going Nuclear Medicine procedures.
Develop an expertise in the palpation of thyroid glands with a particular eye to being able to evaluate size,
texture and possible nodularity.
Provide at least two interesting case study reports for the interesting case file.
Participate in research and educational activities as encountered during their rotation.
Possibly act as a consultant to other physicians seeking urgent or verbal reports of cases they have
reviewed with a senior Nuclear Medicine physician.
Prepare and present cases at Nuclear Medicine rounds as required.ONE
(FIRST 4-WEEK ROTATI2 (OR SECOND 4-WEEK ROTATION)
REQUIRED READING LIST
-
“Essentials of Nuclear Medicine Imaging” by Fred A Mettler
205
-
1.
“Clinical Radionuclide Imaging” by Freeman and Johnson
"Nuclear Medicine: The Requisites" by James H Thrall
Medical Expert
Have a basic understanding of the physics of acquisition of Nuclear Medicine imaging and the
workings of a standard gamma camera. This would include the operation of crystals, photo multiplier
tubes, as well as the various aspects of collimator usage.
Know the anatomy and physiology of the skeleton as it applies to bone scans.
Understand the anatomy and physiology of the lungs as it applies to VQ scans. As well as
understand the categorization of lung scan reports into normal, low, intermediate or high probability
results.
Clinically examine the thyroid gland and understand the common diseases affecting the thyroid gland
including the significance of hot and cold nodules.
Understand the coronary anatomy and cardiac physiology as it applies to functional studies including
stress studies.
Understand the physics behind the production of bone mineral density studies and the application of
bone mineral density studies towards the diagnosis and treatment of osteoporosis.
Understand the therapeutic role of nuclear medicine, in particular, thyroid cancer.
Understand the role of PET scanning.
Understand of the physics behind SPECT reconstruction including the recognition of common
artefacts such as centre of rotation artefact and other quality assurance matters.
Understand the production of radiopharmaceuticals, particularly the role of the moly 99/technetium
99m generator, as well as a grasp of the understanding of radiopharmaceutical kits and the quality
control procedures that must be performed on these kits prior to administration into patients.
Knowledge of the physical characteristics such as half-life photo peak and decay pattern of several
of the more common isotopes will be required.
Have a good understanding of the relative risk of radiation to the patient and, in particular, the risks
involved in both diagnostic and therapeutic Nuclear Medicine procedures, particularly in the
evaluation and treatment of patients with Grave’s disease and thyroid carcinoma.
Understand the nature of digital acquisition images and the role of computers and processing this
information particularly as it applies to functional Nuclear Medicine studies.
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
206
Establish good relationships with peers and other health professionals while effectively providing and
receiving information. Handle conflict situations well.
Produce succinct reports that describe: findings, most likely diagnosis and where appropriate,
recommends further investigation or management.
3.
Collaborator
Contribute to interdisciplinary activities and rounds.
Become an effective consultant of radiology.
Interact effectively with house staff and health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4.
Manager
Understand the quality control procedures related to preparing radiopharmaceuticals for patient
administration.
Understand the effective use of allocation and utilization of health care resources.
Demonstrate competence in and makes use of computer science/information technology as it
pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance and recognizes common artifacts.
5.
Health Advocate
Understand and communicate the benefits and risks of nuclear medicine investigations including the
relative risk of radiation exposure to patients and environment.
Be able to promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
207
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics
and experimental design.
Demonstrate an ability to be an effective teacher.
7.
Professional
Understand issues related to age, gender, culture and ethnicity.
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and maintain appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
208
Obstetrical Ultrasound: PGY4 & PGY5
SUPERVISOR:
Dr. Angela Pickles, Janeway
GOAL:
To become competent in the interpretation and technical aspects of
Obstetrical Ultrasound.
The assessment tools utilized during the rotations include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listing curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists
will also be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES
Supervise and review all obstetrical ultrasonographic examinations. These will subsequently be reviewed
with the staff person prior to dictation by the resident.
Be available for consultation with the technologists and referring physicians/house staff.
Attend biweekly antenatal rounds as necessary.
Be responsible for i) Medical/Surgical rounds with staff supervision and ii) selective subspecialty rounds.
Code any interesting case using the ACR system
Avail of the opportunity to review the gynecological cases as time permits.
Protocol and arrange any fetal MRI’s which arise during the rotation.
REQUIRED READING LIST
1. Rumack and Wilson
2. Callen
3. Society of Obstetrics and Gynecology of Canada web site http://www.sogc.org/guidelines (Clinical
Practice Guidelines for Diagnostic Imaging):
a) Fetal Soft Markers in Obstetric Ultrasound
b) Prenatal Screening for Fetal Aneuploidy
c) The Use of First Trimester Ultrasound
d) Ultrasound Evaluation of First Trimester Pregnancy Complications
e) Content of a Complete Routine Second Trimester Obstetrical Ultrasound Examination and
Report
209
1.
Medical Expert
Know the normal anatomy of 1st and 2nd trimester sonography, including fetal echocardiography.
Be able to perform a complete 2-3 trimester obstetric ultrasound by completion of this rotation. It is
recommended that this be achieved in a step-wise fashion.
Become familiar with transvaginal sonography.
To know the radiology, pathology and clinical aspects of at least the following:
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
2.
normal 1st trimester sonography
abnormal 1st trimester sonography including a) blighted ovum; b) missed complete and
incomplete abortions; c) ectopic pregnancy; d) subchorionic hemorrhage
manifestations of trophoblastic disease
multiple gestations – normal and abnormal
amniotic fluid index, biophysical profile, fetal well-being
common trisomies (21, 18, 13)
common fetal anomalies in all organ subsystems
placental abnormalities, particularly previa and abruption
manifestations of IUGR and use of Doppler
fetal hydrops
prenatal diagnosis
Communicator
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication of adverse outcomes with pregnant patients.
3.
Collaborator
Establish good relationships with peers and other health professionals, particularly the Antenatal
Assessment Unit. Effectively provide and receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
210
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pregnant patient.
Recognize the burden of illness upon the patients served by Radiology.
Know the benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness
guidelines.
6.
Scholar
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Work up cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
211
Pediatrics: Introductory Month
SUPERVISOR:
Dr. Angela Pickles, Janeway
The assessment tools utilized during the rotations include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff. A printout of the complete
required modules from the online curriculum will be required.
DUTIES AND RESPONSIBILITIES
Daily review and reporting of Emergency X-rays.
Daily fluoroscopy lists.
Daily review of neonatal ICU films and general reporting.
As time permits, limited ultrasound exposure, particularly with regard to normal cranial sonography.
Completion of online curriculum.
Radiology rounds for pediatric residents/interns/clerks: when arranged
Selective Pediatric radiology subspecialty rounds: Thursdays: 4:15 pm – 5:00 pm
Medical, surgical or other rounds if requested by supervisor
Working up cases and coding them for the teaching file.
Complete Pediatric Radiology online curriculum sections for Junior Resident, as well as Upper Airway
Inflammation and Inflammatory Neck Lesions. Provide print out of completed courses to Karen. The website
can be accessed at: https://www.cchs.net/onlinelearning/default.htm
* All examinations must be checked with a radiologist prior to reporting.
REQUIRED READING LIST
Introduction to Radiology in Clinical Pediatrics – Haller/Slovis
Appropriate sections from some of the following:
1. Practical Pediatric Imaging – Kirks
2. Emergency Radiology of the Acutely Ill or Injured Child – Swischuk
3. Imaging of the Newborn, Infant and Young Child – Swischuk
212
4. Caffey’s Pediatric Diagnosis
5. Neurosonography section, “ Pediatric Sonography” – Siegel
6. Ultrasound of Infants and Children – Teele
1.
Medical Expert
Become competent in interpreting plain films and performing basic procedures; namely, barium
swallows, UGI’s and follow-throughs, enemas, VCU’s and IVP’s, and fluoroscopy.
Be aware of how to tailor any general procedure to answer the specific clinical concerns, be aware of
radiation dosage and individual exposure in pediatrics.
Learn contrast dosage and treatment of reaction in the pediatric population.
Increase knowledge of anatomy and pathology related to organ systems with specific attention to the
pediatric population.
Start to familiarize yourself with ultrasound/CT/MRI examination for pediatric conditions and related
protocols.
Provide analgesia and sedation to pediatric patients when appropriate (MRI and CT).
Be able to read plain film studies of pediatric patients including the chest and musculoskeletal
system.
Complete Pediatric Radiology online curriculum sections for Junior Resident, as well as Upper
Airway Inflammation and Inflammatory Neck Lesions. Provide print out of completed courses to
Karen. The website can be accessed at: https://www.cchs.net/onlinelearning/default.htm
2.
Communicator
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3.
Collaborator
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
213
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits & risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
Recognize the burden of illness upon the patients served by Radiology.
Know the benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness
guidelines.
6.
Scholar
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Work up cases for the teaching file.
Identify potential research project with supervisors.
7.
Professional
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
214
Pediatrics: PGY4 and PGY5
SUPERVISOR:
Dr. Angela Pickles, Janeway
The assessment tools utilized during the rotations include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listing curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff. A print out of the complete
required modules from the online curriculum will be required.
DUTIES AND RESPONSIBILITIES
Report emergency films daily early a.m.
Fluoroscopy list 2 days per week minimum.
Ultrasound approximately 2 days per week minimum. The resident should be capable of scanning
independently and obtaining diagnostic images. The resident should provide an image of a normal appendix
scanned personally by the end of the rotation. The resident is responsible for reporting the majority of
ultrasounds on scheduled ultrasound days. At least one morning per week (minimum) hands-on scanning.
CT approximately 2 days per week. The resident will review all CT requisitions and decide on protocols with
the staff person. The resident will supervise and subsequently report all a.m. CT’s on scheduled days.
MRI – the resident will review and report the majority of pediatric MRI’s performed during the rotation.
Report non-emergent/ICU general radiology as time permits.
The resident will be responsible for the same rounds and teaching file responsibilities as in the PGY2
rotation.
Completion of online curriculum.
REQUIRED READING LIST
1.
2.
3.
4.
5.
6.
7.
8.
9.
As per PGY2 rotation
Appropriate sections on pediatric and obstetrical ultrasound – Rumack and Wilson
Appropriate sections in CT book – Lee, Sagal and Stanley
Pediatric Body CT – Daneman
Pediatric Neuroimaging – Barkovich
MRI in Pediatric Neuroradiology – Walpert, Barnes
Imaging of the Pediatric Head, Neck and Spine – Castillo Mukherji
Pediatric Sonography – Siegel
Other departmental reference texts
215
1.
Medical Expert
Become competent in interpreting plain films and performing basic procedures; namely, barium
swallows, UGI’s and follow-throughs, enemas, VCU’s and IVP’s, and fluoroscopy.
Be aware of how to tailor any general procedure to answer the specific clinical concerns, be aware of
radiation dosage and individual exposure in pediatrics.
Learn contrast dosage and treatment of reaction in the pediatric population.
Increase knowledge of anatomy and pathology related to organ systems with specific attention to the
pediatric population.
Familiarize yourself with ultrasound/CT/MRI examination for pediatric conditions and related
protocols.
Complete Pediatric Radiology online curriculum sections for Senior Resident, as well as Upper
Airway Inflammation, and Inflammatory Neck Lesions and pediatric brain tumor sections in
Barkovich. Provide print out of completed courses.
The website can be accessed at: https://www.cchs.net/onlinelearning/default.htm
Provide analgesia and sedation to pediatric patients when appropriate (MRI and CT).
Be able to read plain film studies of pediatric patients including the chest and musculoskeletal
system.
2.
Communicator
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3.
Collaborator
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
216
4.
Manager
Learn competence in and make use of computer science/information technology as it pertains to
Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5.
Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
Recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
6.
Scholar
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics
and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Work up cases for the teaching file and identify a potential research project with supervisors.
7.
Professional
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
217
Rural Rotation: PGY4
ROTATION CO-ORDINATOR:
Dr. Bob Cook, WMRH
ROTATION SUPERVISORS:
Dr. Ed Mercer, WMRH
Dr. Bill Casey, WMRH
Dr. Jen Lombard, WMRH
Dr. Andrea Reid, WMRH
Dr. Brent Pilgrim, WMRH
Dr. Gavin White, WMRH
Should we include a line about the plain film exam being done in advance of this rotation?
The following is an outline of the goals and objectives of the Rural rotation during PGY4, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation.
DUTIES AND RESPONSIBILITIES
Function as a community radiologist with exposure to all imaging modalities and subspecialties offered at
the WMRH.
Interpret and report all studies assigned to the supervising staff person. The supervising staff person will
change on a weekly basis. This will include plain films, GI/barium studies, mammography, CT, MRI and US.
Echocardiography and nuclear medicine are only reported by certain staff persons and exposure to these
modalities can be arranged if requested.
To perform, interpret and report procedures assigned to the supervising staff person. This includes GI
procedures, breast biopsies, thyroid biopsies, CT and US-guided biopsies and drainages. Complex
procedures are performed by the interventional staff person and exposure to higher-level interventional
procedures can be arranged if requested.
All “stat” studies should be reviewed and reported the day they are performed. Non-stat studies performed
during any given week should be reviewed and reported by Monday evening of the following week. The
resident is not expected to report any studies performed on the Friday of the last week of the rotation.
Friday AM the exam will be administered and all remaining studies should be reviewed, reported and signed
during the remainder of the day.
To attend interesting case rounds when scheduled.
REQUIRED READING LIST
218
This is a general rotation and, as such, there are no specific reading requirements. One suggestion for
reading during this rotation would be to re-read Brant & Helms “Fundamentals of Diagnostic Radiology” in
preparation for exam-oriented study.
1.
Medical Expert
Become competent in interpreting plain films and performing basic procedures; namely, barium
studies, basic US- and CT-guided procedures.
Be aware of how to tailor any general examination to answer the specific clinical concerns.
Be aware of radiation dosage and individual exposure.
Learn contrast dosage and treatment of adverse reactions.
Increase knowledge of anatomy, physiology and pathology related to all organ systems.
Learn common ultrasound/CT/MRI examination protocols for all organ systems and be able to tailor
this appropriately for specific clinical concerns.
2.
Communicator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3.
Collaborator
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter- and intra-discipline rounds.
4.
Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains
to Diagnostic Radiology.
219
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
5.
Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
6.
Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7.
Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
220
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.
Ultrasound: (HSC) Introductory Month
SUPERVISOR:
Dr. Eric Sala, Health Sciences Centre
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound
rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES
All emergency patients and inpatients are to be checked with the resident by the technologist, and should be
scanned by the resident in achieving the hands on scanning criteria listed below.
It is also the responsibility of the resident to obtain informed consent, as well as assisting staff, for all
patients that are scheduled to undergo ultrasound guided procedures during the rotation period.
As the volume of both emergency and inpatients, as well ultrasound guided procedures, can widely vary
during the course of the rotation, the resident should participate in the evaluation of other cases during the
work day as is reasonably achievable.
As a rough guideline, at least half of the cases preformed in the ultrasound department each day should be
evaluated by the resident, with review by the attending staff.
A contribution each week to interesting case rounds should also be made by the resident, using a case
during the rotation that emphasizes the role of ultrasound in imaging the patient and managing care period.
At least one case during the rotation should be submitted to the department teaching file. This is to be
reviewed with attending staff.
REQUIRED READING LIST


Ultrasound: The Requisites, by Middleton
Learning How to Scan, the Text: Ultrasound Scanning Principles and Protocols by Tempkin
221
1.
Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Know the role of ultrasound in situations of trauma.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
Perform an ultrasound guided biopsy and ultrasound guided drainage.
a.
“Hands On” Scanning:
By the end of the first level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.











Gallbladder: (gallstones/acute cholecystitis)
Liver: (masses)
Kidney: (hydronephrosis and stones)
Transabdominal/Endovaginal Pelvis: (mass/cyst/free fluid)
Testes: torsion/epididyimitis
Lower Extremity: (DVT Study)
Abdominal Aorta: (aneurysm)
Pleural Effusion and Ascites
Normal and Abnormal Intrauterine Early Pregnancy
Thyroid Gland, specifically overall size and echogenicity
Ultrasound guided procedures: basic techniques
ULTRASOUND PHYSICS













Define ultrasound, including the relationship of sound waves using imaging.
Transducer choice: curvi-linear, linear, sector, vector
Generation and detection of ultrasound waves.
Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone,
Frown Hopper Zone.
Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction,
absorption, acoustic impudence pulse echo principles
Straight and narrow sound beams, suprareflection constant sound speed
Beam shape: linear, sector, curved ray.
Probes: transabdominal and endocavitary
Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler.
Image orientation
Image optimization: power output, gain, time gain compensation
Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures
Tissue characteristics: acoustic shadowing and enhancement
222

Focal zone
CLINICAL APPLICATIONS







Liver: normal echotecture, size and shape (including anatomic variants), diffuse
disease: (for example fatty infiltration, acute and chronic hepatitis, cirrhosis, edema),
focal masses, metastasis, granuloma
Gallbladder: normal appearance, wall thickening, gallstones, sludge, acute
cholecystitis (calculus vs acalculus), sonographic Murphy sign, other etiologies of wall
thickening, polyp
Bile ducts: normal, intra and extra hepatic bile duct diameters and dilatation
Pancreas: normal anatomy, pancreatic duct, mass
Spleen: normal echotexture, size and shape (including anatomic variants), focal
masses, cystic versus solid, lymphoma, abscess, infarction, granuloma
Peritoneal cavity: ascites, fluid localization/quantification(free versus loculated)
Pleural effusion
GENITOURINARY SYSTEM



Normal kidney cortical echotexture, size and shape, medical renal disease, simple
renal cyst
Ureters: hydronephrosis and pylenephrosis
Urinary bladder: caliculi, wall thickening, urethral jets, bladder volume
GYNECOLOGY





Uterus: normal size, shape, position, echogenicity, fibroid identification
Endometrium: normal appearance during phases of menstrual cycle and thickness
measurement (premenopausal, postmenopausal, effects of hormone replacement),
IUD, fluid
Ovary: normal size, shape, echogenicity, physiologic variation during phases of the
menstrual cycle (follicles, corpus luteum, hemorrhagic ovarian cyst)
Free pelvic fluid
First trimester ultrasound: normal gestational sac appearance, size, gestational sac
growth, yolk sac, embryo, cardiac activity including normal embryonic heart rate,
normal early fetal anatomy/growth, crown rump link measurement, correlation with
beta HCG levels and menstrual dates
THYROID/NECK



Normal thyroid echotexture, size and shape
Thyroid disease: diffuse and focal disease
Multinodular thyroid, evaluation of neck lymph nodes
VASCULAR/DOPPLER
223





Abdominal Aorta: normal appearance and measurement, aneurysm
Inferior vena cava: normal appearance, thrombosis
Lower extremity DVT
Hematoma
Pseudoaneurysm
SCROTUM




Testes: normal echotexture and shape and size
Epididymis
Testicular mass
Hydrocele
MUSCULOSKELETAL



Mass
Hematoma, Baker’s cyst, incomplete rupture
Abscess
INTERVENTIONAL





Informed consent
Sterile technique
Localization of fluid for paracentesis or thoracentesis, with ultrasound guided
aspiration of same
Techniques for ultrasound guided invasive procedures: understanding important
landmarks and pit falls of percutaneous procedures including recognition of critical
structures
Random core solid visceral biopsies
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2.
Communicator
Dictate prompt, accurate and concise reports for ultrasound studies
Development effective communication skills with patients, patient families, physicians and other
members of the health care team.
Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring
physicians or clinicians while documenting the communication in the report.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behaviour when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam
224
3.
Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4.
Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions.
Participate in quality assurance programs for sonographers and physicians.
Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5.
Health Advocate
Understand the bio effect and safety issues in diagnostic ultrasound.
6.
Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate critical assessment of the scientific literature.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7.
Professional
225
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate positive work habits, including punctuality and professional appearance.
Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient
information.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
226
Ultrasound: (HSC) PGY 3
SUPERVISOR:
Dr. Eric Sala, Health Sciences
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound
rotation during PGY3, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES

In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of
the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the
daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed
consent and assisting attending staff with all ultrasound guided procedures.

Weekly contribution to interesting case rounds with a case specifically pertaining to the role of
sonography is expected. Also, a contribution of at least one case per rotation to the departmental
teaching file is also expected.
REQUIRED READING LIST
1.

The two volume set: Diagnostic Ultrasound, by Rumack and Wilson
Apart from early pregnancy, the chapters relevant to the rotations at the adult hospitals are contained
within the first volume.

Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
227
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Know the role of ultrasound in situations of trauma.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
Perform an ultrasound guided biopsy and ultrasound guided drainage.
a.
“Hands On” Scanning:
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.










Pancreas: (pancreatitis and mass)
Biliary Tree: (common bile duct and ductal dilatation)
Abdominal Mass/Adenopathy
Kidney: (mass/cyst)
Basic Doppler: (portal vein, pseudoaneurysm and AV fistula)
Early Pregnancy: (failed pregnancy)
Adnexal Mass: (ovarian and non ovarian)
Testes: (pain and masses)
Thyroid Nodules
Continue to refine ultrasound guided procedural skills
ULTRASOUND PHYSICS














Define ultrasound, including the relationship of sound waves using imaging.
Transducer choice: curvi-linear, linear, sector, vector
Generation and detection of ultrasound waves.
Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone,
Frown Hopper Zone.
Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction,
absorption, acoustic impudence pulse echo principles
Straight and narrow sound beams, suprareflection constant sound speed
Beam shape: linear, sector, curved ray.
Probes: transabdominal and endocavitary
Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler.
Image orientation
Image optimization: power output, gain, time gain compensation
Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures
Tissue characteristics: acoustic shadowing and enhancement
Focal zone
CLINICAL APPLICATIONS





Liver: hematoma, biloma, abscess
Post liver transplantation/surgery collections: hematoma, biloma, abscess
Gallbladder: hyperplastic cholecystosis, carcinoma
Bile ducts: bile duct stones, inflammatory disease, cholangitis, pneumobilia
Pancreas: neoplasm, cysts
228

Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic
pancreatitis
 Peritoneal cavity: abscess, hemorrhage, omental mass, metastases, carcinocmatosis
 Spleen: varices
GENITOURINARY SYSTEM






Abscess/pyelonephritis, perinephric fluid
Post renal transplant collections: hematoma, uronoma, abscess, lymphocele
Complex renal cyst, adult polycystic kidney disease, acquired kidney cystic disease,
renal cell carcinoma, angiomyelolypoma
Bladder: mass, infection, hemorrhage, wall thickening, bladder outlet obstruction,
diverticulae, urethrocele
Transabdominal prostate
Ureters: hydroureter
GYNECOLOGY








Uterus: congenital anomalies, endometrial polyp, endometrial hyperplasia,
endometrial carcinoma, endometritis, pyelometrium, fibroid localization (submucosal,
intramural and subsurrousal) adenomyosis
Ovarian cyst: hemorrhagic/ruptured cyst, endometrioma, polycystic ovarian disease,
over and hyper stimulation syndrome
Ovarian neoplasm: cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid,
fibroma, germ cell tumor, Doppler evaluation
Ovarian torsion: pelvic inflammatory disease, tube ovarian abscess
Cervix: mass, stenosis, endometrial obstruction
Fallopian tube: hydrosalpinx, pyosalpinx
Posthysterectomy
Early obstetrics: spontaneous complete/incomplete abortion, ectopic pregnancy,
blighted ovum, embryonic death, subcryonic hematoma, gestational tripoblastic
disease
THYROID/NECK


Thyroid nodule characterization: echotexture, calcifications including
microcalcifications, margins, recommendations for aspiration biopsy
Hashimoto’s thyroiditis/Graves disease
VASCULAR/DOPPLER






Peripheral aneurysm, including iliac and popliteal arteries
Hepatic vasculature: post and color Doppler imaging of the portal veins, splenic vein,
hepatic arteries and hepatic veins, including normal direction of flow
Hemodynamics of cirrhosis, portal hypertension and varices, portal vein
Thrombosis
Upper extremity DVT
Renal vein thrombosis
SCROTUM
229







Epididymitis, orchitis
Testicular torsion
Testicular mass characterization: microlithiasis, germ cell tumor, lymphoma,
metastases
Cystic ectasia of mediastinum testes
Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head
cyst
Varicocele
Trauma
MUSCULOSKELETAL






Normal tendon appearance
Foreign body
Soft tissue gas
Joint fluid
Muscle tear
Rotator cuff tear
INTERVENTIONAL




Biopsy of soft tissue masses as well as focal solid visceral masses
Aspiration of fluid collections, cysts and catheter placement for abscess and fluid
drainage
Postprocedural evaluation: radiographic studies, patient monitoring, management of
complications
Fine needle biopsy versus core biopsy and specific applications, including focal, liver
and renal masses, thyroid lesions and retroperitoneal adenopathy
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2.
Communicator
Dictate prompt, accurate and concise reports for ultrasound studies.
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring
physicians or clinicians while documenting the communication in the report.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
230
3.
Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4.
Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions.
Participate in quality assurance programs for sonographers and physicians.
Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5.
Health Advocate
Understand the bio effect and safety issues in diagnostic ultrasound.
6.
Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate critical assessment of the scientific literature.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
231
7.
Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate positive work habits, including punctuality and professional appearance.
Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient
information.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
232
Ultrasound (HSC): Senior Rotations (PGY 4 & 5)
SUPERVISOR:
Dr. Eric Sala, Health Sciences Centre
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound
rotation during PGY4 & 5, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES

At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover
the entire working of the department during the day. This includes reviewing all cases, as well as
obtaining informed consent for all ultrasound guided procedures.

Assisting the attending staff as well as independently performing these procedures is expected.

Continued weekly contribution to the interesting case rounds as well as the preparation of a case for
the departmental teaching file is also expected.
REQUIRED READING LIST
1.

The two volume set: Diagnostic Ultrasound, by Rumack and Wilson
Apart from early pregnancy, the chapters relevant to the rotations at the adult hospitals are contained
within the first volume.

Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
233
Know the role of ultrasound in situations of trauma.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
Perform an ultrasound guided biopsy and ultrasound guided drainage.
a.
“Hands On” Scanning:
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.



Parathyroid, paracarotid artery and Doppler
Advanced Abdominal Doppler: (visceral organs and organ transplant)
Peripheral Vessels
ULTRASOUND PHYSICS
In addition to the knowledge acquired in prior ultrasound rotations:














Doppler phenomenon, Doppler formula
Beam formation and focusing
Gray-scale, m-mode, pulse wave Doppler, color Doppler imaging, power Doppler
imaging
Beam width, side load, slice thickness artefacts
Multiple reflection artefacts: mirror image/reverberation
Refractive artefacts
Doppler artefacts: pulse wave, color imaging including ileising
Gray scale versus Doppler: (trade off of penetration and resolution)
3D volumetric imaging
Thermal/nonthermal effects on tissues: (biological health risks)
Image optimization
Hermonic imaging
Ultrasound contrast agents
Equipment quality assurance: phantoms, special/contrast resolution
CLINICAL APPLICATIONS








Liver: trauma
Bile ducts: neoplasm (cholangiocarcinoma)
Spleen: trauma
Chest: pericardial effusion, mass, atelectasis, pneumonia
Organ transplants
Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease
Peritoneal cavity: free air
Abdominal wall hernia and inguinal hernia
GENITOURINARY SYSTEM


Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis,
congenital anomalies, pelvic kidney, medullary nephrocalcinosis
Adrenal glands: mass
234




Retroperitoneum: adenopathy and mass
Ureters: ureteral stone
Bladder: ectopic ureterocele
Renal artery stenosis, renal vein thrombosis
GYNECOLOGY



Peritoneal inclusion cyst
Ovarian cancer staging
Early obstetrics: unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary
horn)
THYROID/NECK





Parathyroid mass
Congenital cyst: brachial cleft cyst
Lymph nodes: benign and malignant characterization
Post thyroidectomy recurrence
Submandibular and parotid glands: normal and abnormal
VASCULAR/DOPPLER










Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion
AV fistula
Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein
thrombosis, renal infarction, post biopsy complications, renal artery stenosis
Liver transplants, including hepatic artery stenosis or thrombosis, portal vein
thrombosis, post biopsy complications, IVC stenosis
Pancreas transplant
TIPS evaluation and complications
Arterial bypass graft, hemodialysis graft/fistula
Vertebral artery: subclavian steal syndrome
Mesenteric ischemia
Renal artery stenosis
SCROTUM



Hernia
Non descended testes
Fournier’s Gangrene
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2.
Communicator
Dictate prompt, accurate and concise reports for ultrasound studies.
235
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring
physicians or clinicians while documenting the communication in the report.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
3.
Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4.
Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions.
Participate in quality assurance programs for sonographers and physicians.
Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5.
Health Advocate
Understand the bio effect and safety issues in diagnostic ultrasound.
6.
Scholar
236
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate critical assessment of the scientific literature.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7.
Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate positive work habits, including punctuality and professional appearance.
Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient
information.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
237
Ultrasound: (SCM) Introductory Month
SUPERVISOR:
Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY2, incorporated
into CANMEDS format. The medical expert expectations have been organized by year. The remaining
CANMEDS roles will be assessed throughout all rotations & will remain consistent throughout residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES
All emergency patients and inpatients are to be checked with the resident by the technologist, and should be
scanned by the resident in achieving the hands on scanning criteria listed below.
It is also the responsibility of the resident to obtain informed consent, as well as assisting staff, for all
patients that are scheduled to undergo ultrasound guided procedures during the rotation period.
As the volume of both emergency and inpatients, as well ultrasound guided procedures, can widely vary
during the course of the rotation, the resident should participate in the evaluation of other cases during the
work day as is reasonably achievable.
As a rough guideline, at least half of the cases preformed in the ultrasound department each day should be
evaluated by the resident, with review by the attending staff.
A contribution each week to interesting case rounds should also be made by the resident, using a case
during the rotation that emphasizes the role of ultrasound in imaging the patient and managing care period.
At least one case during the rotation should be submitted to the department teaching file. This is to be
reviewed with attending staff.
REQUIRED READING LIST


1.
Ultrasound: The Requisites, by Middleton
Learning How to Scan, the Text: Ultrasound Scanning Principles and Protocols by Tempkin
Medical Expert
In addition to the acquisition of knowledge specific to ultrasound , there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
238
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Know the role of ultrasound in situations of trauma.
Recognize & give the differential diagnosis of a lesion based on its anatomical location & echogenicity
Perform an ultrasound guided biopsy and ultrasound guided drainage.
a.
“Hands On” Scanning:
By the end of the first level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.











Gallbladder: (gallstones/acute cholecystitis)
Liver: (masses)
Kidney: (hydronephrosis and stones)
Transabdominal/Endovaginal Pelvis: (mass/cyst/free fluid)
Testes: torsion/epididyimitis
Lower Extremity: (DVT Study)
Abdominal Aorta: (aneurysm)
Pleural Effusion and Ascites
Normal and Abnormal Intrauterine Early Pregnancy
Thyroid Gland, specifically overall size and echogenicity
Ultrasound guided procedures: basic techniques
ULTRASOUND PHYSICS














Define ultrasound, including the relationship of sound waves using imaging.
Transducer choice: curvi-linear, linear, sector, vector
Generation and detection of ultrasound waves.
Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone,
Frown Hopper Zone.
Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction,
absorption, acoustic impudence pulse echo principles
Straight and narrow sound beams, suprareflection constant sound speed
Beam shape: linear, sector, curved ray.
Probes: transabdominal and endocavitary
Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler.
Image orientation
Image optimization: power output, gain, time gain compensation
Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures
Tissue characteristics: acoustic shadowing and enhancement
Focal zone
CLINICAL APPLICATIONS


Liver: normal echotecture, size and shape (including anatomic variants), diffuse
disease: (for example fatty infiltration, acute and chronic hepatitis, cirrhosis, edema),
focal masses, metastasis, granuloma
Gallbladder: normal appearance, wall thickening, gallstones, sludge, acute
cholecystitis (calculus vs acalculus), sonographic Murphy sign, other etiologies of wall
thickening, polyp
239





Bile ducts: normal, intra and extra hepatic bile duct diameters and dilatation
Pancreas: normal anatomy, pancreatic duct, mass
Spleen: normal echotexture, size and shape (including anatomic variants), focal
masses, cystic versus solid, lymphoma, abscess, infarction, granuloma
Peritoneal cavity: ascites, fluid localization/quantification(free versus loculated)
Pleural effusion
GENITOURINARY SYSTEM



Normal kidney cortical echotexture, size and shape, medical renal disease, simple
renal cyst
Ureters: hydronephrosis and pylenephrosis
Urinary bladder: caliculi, wall thickening, urethral jets, bladder volume
GYNECOLOGY




Uterus: normal size, shape, position, echogenicity, fibroid identification
Endometrium: normal appearance during phases of menstrual cycle and thickness
measurement (premenopausal, postmenopausal, effects of hormone replacement),
IUD, fluid
Ovary: normal size, shape, echogenicity, physiologic variation during phases of the
menstrual cycle (follicles, corpus luteum, hemorrhagic ovarian cyst)
Free pelvic fluid
THYROID/NECK



Normal thyroid echotexture, size and shape
Thyroid disease: diffuse and focal disease
Multinodular thyroid, evaluation of neck lymph nodes
VASCULAR/DOPPLER





Abdominal Aorta: normal appearance and measurement, aneurysm
Inferior vena cava: normal appearance, thrombosis
Lower extremity DVT
Hematoma
Pseudoaneurysm
SCROTUM




Testes: normal echotexture and shape and size
Epididymis
Testicular mass
Hydrocele
MUSCULOSKELETAL


Mass
Hematoma, Baker’s cyst, incomplete rupture
240

Abscess
INTERVENTIONAL





Informed consent
Sterile technique
Localization of fluid for paracentesis or thoracentesis, with ultrasound guided
aspiration of same
Techniques for ultrasound guided invasive procedures: understanding important
landmarks and pit falls of percutaneous procedures including recognition of critical
structures
Random core solid visceral biopsies
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2.
Communicator
Dictate prompt, accurate and concise reports for ultrasound studies.
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring
physicians or clinicians while documenting the communication in the report.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
3.
Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident reviewing cases & performing procedures.
4.
Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Effectively prioritize patients requiring ultrasound studies.
241
Use information technology to support patient care decisions.
Participate in quality assurance programs for sonographers and physicians.
Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5.
Health Advocate
Understand the bio effect and safety issues in diagnostic ultrasound.
6.
Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate critical assessment of the scientific literature.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7.
Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate positive work habits, including punctuality and professional appearance.
Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient
information.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
242
Ultrasound: (SCM) PGY 3
SUPERVISOR:
Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY3, incorporated
into CANMEDS format. The medical expert expectations have been organized by year. The remaining
CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of
residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES

In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of
the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the
daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed
consent and assisting attending staff with all ultrasound guided procedures.

Weekly contribution to interesting case rounds with a case specifically pertaining to the role of
sonography is expected. Also, a contribution of at least one case per rotation to the departmental
teaching file is also expected.
REQUIRED READING LIST
1.

The two volume set: Diagnostic Ultrasound, by Rumack and Wilson
The chapters relevant to the rotation are contained within the first volume.

Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Know the role of ultrasound in situations of trauma.
243
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
Perform an ultrasound guided biopsy and ultrasound guided drainage.
a.
“Hands On” Scanning:
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.










Pancreas: (pancreatitis and mass)
Biliary Tree: (common bile duct and ductal dilatation)
Abdominal Mass/Adenopathy
Kidney: (mass/cyst)
Basic Doppler: (portal vein, pseudoaneurysm and AV fistula)
Early Pregnancy: (failed pregnancy)
Adnexal Mass: (ovarian and non ovarian)
Testes: (pain and masses)
Thyroid Nodules
Continue to refine ultrasound guided procedural skills
ULTRASOUND PHYSICS














Define ultrasound, including the relationship of sound waves using imaging.
Transducer choice: curvi-linear, linear, sector, vector
Generation and detection of ultrasound waves.
Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone,
Frown Hopper Zone.
Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction,
absorption, acoustic impudence pulse echo principles
Straight and narrow sound beams, suprareflection constant sound speed
Beam shape: linear, sector, curved ray.
Probes: transabdominal and endocavitary
Display: Gray-scale, m-mode, pulse wave Doppler, color and power Doppler.
Image orientation
Image optimization: power output, gain, time gain compensation
Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures
Tissue characteristics: acoustic shadowing and enhancement
Focal zone
CLINICAL APPLICATIONS







Liver: hematoma, biloma, abscess
Gallbladder: hyperplastic cholecystosis, carcinoma
Bile ducts: bile duct stones, inflammatory disease, cholangitis, pneumobilia
Pancreas: neoplasm, cysts
Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic
pancreatitis
Peritoneal cavity: abscess, hemorrhage, omental mass, metastases, carcinocmatosis
Spleen: varices
244
GENITOURINARY SYSTEM






Abscess/pyelonephritis, perinephric fluid
Post renal transplant collections: hematoma, uronoma, abscess, lymphocele
Complex renal cyst, adult polycystic kidney disease, acquired kidney cystic disease,
renal cell carcinoma, angiomyelolypoma
Bladder: mass, infection, hemorrhage, wall thickening, bladder outlet obstruction,
diverticulae, urethrocele
Transabdominal prostate
Ureters: hydroureter
GYNECOLOGY








Uterus: congenital anomalies, endometrial polyp, endometrial hyperplasia,
endometrial carcinoma, endometritis, pyelometrium, fibroid localization (submucosal,
intramural and subsurrousal) adenomyosis
Ovarian cyst: hemorrhagic/ruptured cyst, endometrioma, polycystic ovarian disease,
over and hyper stimulation syndrome
Ovarian neoplasm: cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid,
fibroma, germ cell tumor, Doppler evaluation
Ovarian torsion: pelvic inflammatory disease, tube ovarian abscess
Cervix: mass, stenosis, endometrial obstruction
Fallopian tube: hydrosalpinx, pyosalpinx
Posthysterectomy
Early obstetrics: spontaneous complete/incomplete abortion, ectopic pregnancy,
blighted ovum, embryonic death, subcryonic hematoma, gestational tripoblastic
disease
THYROID/NECK


Thyroid nodule characterization: echotexture, calcifications including
microcalcifications, margins, recommendations for aspiration biopsy
Hashimoto’s thyroiditis/Graves disease
VASCULAR/DOPPLER






Peripheral aneurysm, including iliac and popliteal arteries
Hepatic vasculature: post and color Doppler imaging of the portal veins, splenic vein,
hepatic arteries and hepatic veins, including normal direction of flow
Hemodynamics of cirrhosis, portal hypertension and varices, portal vein
Thrombosis
Upper extremity DVT
Renal vein thrombosis
SCROTUM



Epididymitis, orchitis
Testicular torsion
Testicular mass characterization: microlithiasis, germ cell tumor, lymphoma,
metastases
245




Cystic ectasia of mediastinum testes
Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head
cyst
Varicocele
Trauma
MUSCULOSKELETAL






Normal tendon appearance
Foreign body
Soft tissue gas
Joint fluid
Muscle tear
Rotator cuff tear
INTERVENTIONAL




Biopsy of soft tissue masses as well as focal solid visceral masses
Aspiration of fluid collections, cysts and catheter placement for abscess and fluid
drainage
Postprocedural evaluation: radiographic studies, patient monitoring, management of
complications
Fine needle biopsy versus core biopsy and specific applications, including focal, liver
and renal masses, thyroid lesions and retroperitoneal adenopathy
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2.
Communicator
Dictate prompt, accurate and concise reports for ultrasound studies.
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring
physicians or clinicians while documenting the communication in the report.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
246
3.
Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4.
Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions.
Participate in quality assurance programs for sonographers and physicians.
Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5.
Health Advocate
Understand the bio effect and safety issues in diagnostic ultrasound.
6.
Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate critical assessment of the scientific literature.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
247
7.
Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate positive work habits, including punctuality and professional appearance.
Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient
information.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
248
Ultrasound: (SCM) Senior Rotations (PGY 4 & 5)
SUPERVISOR:
Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY4 & 5,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff.
DUTIES AND RESPONSIBILITIES
At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover the
entire working of the department during the day. This includes reviewing all cases, as well as obtaining
informed consent for all ultrasound guided procedures.
Assisting the attending staff as well as independently performing these procedures is expected.
Continued weekly contribution to the interesting case rounds as well as the preparation of a case for the
departmental teaching file is also expected.
REQUIRED READING LIST
1.

The two volume set: Diagnostic Ultrasound, by Rumack and Wilson
The chapters relevant are contained within the first volume.

Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Know the role of ultrasound in situations of trauma.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
249
Perform an ultrasound guided biopsy and ultrasound guided drainage.
a.
“Hands On” Scanning:
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.



Parathyroid, paracarotid artery and Doppler
Advanced Abdominal Doppler: (visceral organs and organ transplant)
Peripheral Vessels
ULTRASOUND PHYSICS
In addition to the knowledge acquired in prior ultrasound rotations:














Doppler phenomenon, Doppler formula
Beam formation and focusing
Gray-scale, m-mode, pulse wave Doppler, color Doppler imaging, power Doppler
imaging
Beam width, side load, slice thickness artefacts
Multiple reflection artefacts: mirror image/reverberation
Refractive artefacts
Doppler artefacts: pulse wave, color imaging including ileising
Gray scale versus Doppler: (trade off of penetration and resolution)
3D volumetric imaging
Thermal/nonthermal effects on tissues: (biological health risks)
Image optimization
Hermonic imaging
Ultrasound contrast agents
Equipment quality assurance: phantoms, special/contrast resolution
CLINICAL APPLICATIONS







Liver: trauma
Bile ducts: neoplasm (cholangiocarcinoma)
Spleen: trauma
Chest: pericardial effusion, mass, atelectasis, pneumonia
Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease
Peritoneal cavity: free air
Abdominal wall hernia and inguinal hernia
GENITOURINARY SYSTEM






Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis,
congenital anomalies, pelvic kidney, medullary nephrocalcinosis
Adrenal glands: mass
Retroperitoneum: adenopathy and mass
Ureters: ureteral stone
Bladder: ectopic ureterocele
Renal artery stenosis, renal vein thrombosis
GYNECOLOGY
250



Peritoneal inclusion cyst
Ovarian cancer staging
Early obstetrics: unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary
horn)
THYROID/NECK





Parathyroid mass
Congenital cyst: brachial cleft cyst
Lymph nodes: benign and malignant characterization
Post thyroidectomy recurrence
Submandibular and parotid glands: normal and abnormal
VASCULAR/DOPPLER









Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion
AV fistula
Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein
thrombosis, renal infarction, post biopsy complications, renal artery stenosis
Liver transplants, including hepatic artery stenosis or thrombosis, portal vein
thrombosis, post biopsy complications, IVC stenosis
TIPS evaluation and complications
Arterial bypass graft, hemodialysis graft/fistula
Vertebral artery: subclavian steal syndrome
Mesenteric ischemia
Renal artery stenosis
SCROTUM



Hernia
Non descended testes
Fournier’s Gangrene
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2.
Communicator
Dictate prompt, accurate and concise reports for ultrasound studies.
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring
physicians or clinicians while documenting the communication in the report.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
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Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
3.
Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4.
Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Effectively prioritize patients requiring ultrasound studies.
Use information technology to support patient care decisions.
Participate in quality assurance programs for sonographers and physicians.
Be aware of equipment quality assurance programs.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5.
Health Advocate
Understand the bio effect and safety issues in diagnostic ultrasound.
6.
Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate critical assessment of the scientific literature.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
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Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7.
Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate positive work habits, including punctuality and professional appearance.
Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient
information.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
Demonstrate accountability to the patients, society and the profession.
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
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Appendix One
Policy
Office of Accountability:
Postgraduate Medical Education
Office of Administrative Responsibility:
Postgraduate Medical Education
Approver:
Postgraduate Medical Studies Committee
Overview
Resident education must occur in a physically safe environment (Royal College of Physicians and Surgeons
of Canada, standard A.2.5; College of Family Physicians of Canada).
The collective agreement between the Professional Association of Interns and Residents of NL (PAIRN)
states that residents are postgraduate trainees registered in university programs as well as physicians
employed by the hospitals. The agreement states that the residents must have secure and private rooms
with secure access between call room facilities and the service area; maximum duty hours are defined;
uniforms and protective equipment standards; as well as access to and coverage for Occupational Health
services.
Memorial University is committed to provide and maintain healthy and safe working and learning
environments for all employees, trainees (including postgraduate trainees), volunteers and visitors. This is
achieved by observing best practices which meet or exceed the standards to comply with legislative
requirements as contained in the NL Occupational Health and Safety Act, Environmental Protection Act,
Nuclear Safety and Control Act and other statutes, their regulations, and the policy and procedures
established by the University.
Purpose
To demonstrate the commitment of Postgraduate Medicine, Faculty of Medicine, to health, safety and
protection of its postgraduate medical trainees.
To minimize the risk of injury and promote a safe and healthy environment on the university campus and
affiliated teaching sites
To provide a procedure to report hazardous or unsafe training conditions and injury along with a mechanism
to take corrective action
Policy
PERSONAL SAFETY
Memorial University, Faculty of Medicine strives for a safe and secure environment for postgraduate trainees
to train in its facilities and training sites through maintenance of affiliation agreements. Affiliated hospitals
are responsible for ensuring the safety and security of postgraduate trainees training and supervision in their
facilities in compliance with their existing employee safety and security policies/procedures as well as the
requirements outlined in the PAIRN – Eastern Health collective agreement.
254
It is expected that the Postgraduate Trainee, the Residency Program and the Postgraduate Medical
Education Office will work together with the affiliated teaching hospitals and community training sites to
ensure the personal safety of all Postgraduate trainees.
Accommodation
When trainees rotate in sites that are out of town accommodations should have adequate security and
lighting, safe locks and security personnel available to accompany the trainee to their residence after dark.
Responsibility
1. Postgraduate Trainee
It is the responsibility of the trainee to participate in required safety sessions, which include
Workplace Hazardous Materials Information and Safety (WHMIS), Fire Safety (as required), etc. and
abide by the Safety codes of the designated area where s / he is training. This includes dress codes,
particularly as they relate to safety.
The Postgraduate trainee must report any situation where personal safety is threatened (see Faculty
Protocol below).
2. Residency Program and the Postgraduate Medical Education Office
It is a responsibility of each Residency Program and the Postgraduate Medical Education Office to
ensure that appropriate educational safety sessions are available to all Postgraduate Trainees e.g.,
generic WHMIS and safety training. In addition to WHMIS, the Residency Program must ensure that
there is an initial, specialty, site-specific orientation available to the Postgraduate trainee.
It is the responsibility of the Residency Program to ensure that individual clinics or practice settings
develop a site specific protocol to deal with:
•
•
•
•
patient(s) who may represent a safety risk and policies
working alone
working in isolated areas or situations e.g., medivac transports
or any other situation that may be a safety issue to the Postgraduate Trainee
The protocol must be communicated to the Postgraduate Trainee at the beginning of the rotation.
The Postgraduate Medical Education Office will work, in conjunction with the affiliated Newfoundland and
Labrador teaching hospitals to ensure that hospital areas are in compliance with the requirements as
outlined in the PAIRN – Eastern Health collective agreement.
Site Specific Protocol
The protocol should include the following:
•
•
•
identify potential risks to the Postgraduate Trainee
include how the Postgraduate Trainee is seeing a patient after hours in clinic. This would
encounter, identification of potentially problematic patients at the beginning of the encounter
so they could be monitored
a supervisor* or co-worker must be available
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a. while the Postgraduate Trainee is seeing a patient after hours in clinic. This would not
apply if the patient is being seen in an emergency room / hospital based urgent care
clinic, nursing home and hospice
b. when the Postgraduate Trainee does home visits
c. at the end of office hours if the Postgraduate Trainee is still with patients
*The supervisor as defined by the Occupational Health and Safety Act – “a person who has charge of a
workplace or authority over any worker.” It can be a physician (including another Postgraduate Trainee),
midwife, nurse practitioner or social worker depending on the encounter.
Faculty Protocol
Postgraduate Trainees identifying a personal safety or security breach:
1. If a Postgraduate Trainee identifies a personal safety or security breach, it must be reported to their
immediate supervisor and/or Program Director to allow resolution of the issue at the local level.
2. If a Postgraduate Trainee feels that his / her own personal safety is threatened, s/he should seek
immediate assistance and remove themselves from the situation in a professional manner. The
Postgraduate Trainee should ensure that their immediate supervisor has been notified and/or
Program Director, as appropriate.
3. The Postgraduate Medical Education Office is available for consultation during regular work hours,
particularly if the Program Director is not available. If an issue arises after regular office hours, where
the clinical supervisor and/or Program Director may not be available, contact Security of the institution
where the Postgraduate trainee is based.
Travel
If in the residents’ estimation, it would not be safe to travel because of weather, the resident may elect not to
attend their academic half day, clinic, etc., but must inform the appropriate people as soon as possible in a
professional manner.
Training Outside North America
Postgraduate Trainees must complete the Field Trips and Electives Planning and Approval process when
planning to do an elective outside of North America to ensure compliance with standards and best practices
for the safety of all Postgraduate Trainees
WORKPLACE ENVIRONMENTAL HEALTH AND SAFETY
(e.g. hazardous material (biological or chemical agent named in the Occupational Health and Safety Act),
indoor air quality, chemical spills)
OCCUPATIONAL HEALTH
(e.g. immunization policies, blood borne pathogens, respiratory protection)
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Both Memorial University and its employees are jointly responsible for implementing and maintaining an
Internal Responsibility System directed at promoting health and safety, preventing incidents involving
occupational injuries and illnesses or adverse effects upon the natural environment.
The University is responsible for the provision of information, training, equipment and resources to support
the Internal Responsibility System and ensure compliance with all relevant statutes, this policy and internal
health and safety programs. Managers, Supervisors, Deans, Directors, Chairs, Research Supervisors are
accountable for the safety of postgraduate trainees who work/study within their area of jurisdiction.
Postgraduate trainees are required by University policy to comply with all University health, safety and
environmental programs such as Workplace Hazardous Materials Information and Safety (WHMIS).
The Faculty of Medicine and the teaching hospitals each are responsible for ensuring that postgraduate
trainees are adequately instructed in infection prevention and control as it relates to communicable
diseases.
The Faculty and the teaching hospitals will provide an introductory program on routine practices / standard
precautions, infection protection and control that is consistent with current guidelines and occupational
health and safety. In addition, the Faculty and the teaching hospitals will inform postgraduate trainees as to
their responsibilities with respect to infection prevention and control and occupational health and safety.
Affiliated teaching hospitals are required to comply with the Communicable Disease Surveillance Protocols
for Newfoundland and Labrador Hospitals. Compliance with these Protocols requires the hospitals, in
liaison with the University’s academic programs, to provide instruction in infection prevention and control and
occupational health and safety.
The Faculty Postgraduate Medical Education Office collects the immunization data on all Postgraduate
Trainees on behalf of the teaching hospitals.
If an injury occurs while working, the injury must be reported as follows (Refer to Chart 1 on page 7)
•
During daytime hours, while working at one of the Newfoundland and Labrador hospitals:
The Postgraduate Trainee should go to the Employee Health Office at any of the teaching hospitals.
An incident form will be provided by the Employee Health office to the Postgraduate Trainee.
Reporting: All trainees are encouraged to submit a copy of the incident form to their home program
for notification. The home program will send a copy to the Postgraduate Medical Education Office for
University records. Non-Ministry of Health funded trainees: (e.g., foreign sponsored Residents
and all Clinical Fellows *) must submit a copy of the incident form to the Postgraduate Medical
Education Office, in order for the PGME Office to notify their sponsor and ensure proper follow-up.
Occupational Health & Safety Office of the University will be notified.
Postgraduate Medical Education Office (PGME)
Phone: 709-777-6680 Fax: 709-777-8377
•
During the evening or on the weekend at one of the Newfoundland and Labrador teaching hospitals
or if working at a training site outside of the Newfoundland and Labrador area
The Postgraduate Trainee should go to the nearest Emergency Room and identify themselves as a
Resident / Clinical Fellow and request to be seen on an urgent basis. The Postgraduate
Trainee must complete, within 24 hours, an Injury/Incident Report (forms should be available in the
local Emergency Room).
257
The injury/incident form should be submitted to the hospital where the injury took place.
hospital will be responsible for administering the claim.
That
*The Postgraduate Trainee’s employer administers the claim. All Ministry of Health funded Residents are
paid through Eastern Health. There are a variety of different funding sources for externally funded
Residents and Clinical Fellows. In these instances, HHS would not administer the claim or be responsible
for follow-up. Important: Please see Appendix 1 for information on follow-up.
Resources available:
Postgraduate Medical Education Office
Phone:
Fax:
709-777-6680
709-777-6680
Definitions
There are no definitions at this time.
RELATED LINKS
Liaison Committee on Medical Education: http://www.lcme.org
Procedure
Definitions
Term
Definitions are optional.
There are no Forms for this Procedure
Related Links
Further RELATED LINKS are optional. List hyperlinks to further information that the user may need to fully
understand this PROCEDURE. This may include links to other documents in UAPPOL, legislation,
agreements, or external regulations. Links should only lead to the official publication source for these
documents on a site that will always be current and updated (such as the Government of Alberta Queen’s
Printer site).
List links in alphabetical order, indicating title of link and destination, as in the following examples:
258
Appendix Two
A Guide to Developing Good Clinical Skills and Attitudes.
PATIENT RELATIONSHIPS:
Acceptable behaviour:
Unacceptable behaviour:
1.
Gives patients confidence.
1.
Difficulty in understanding patient's needs.
2.
Relieves their anxieties.
2.
Alarms patients needlessly.
3.
Bases his/her interactions on his/her honest
opinion.
3.
Reacts poorly to emotional or hostile
behaviour.
4.
Empathizes with patients.
4.
Unable to exhibit sympathy or compassion.
5.
Patients like and talk easily to him/her.
5.
Unable to see the patient's point of view.
6.
Patients can discuss intimate and sensitive
details with him/her.
6.
Becomes dependent on the emotional
content of the doctor/patient relationship.
7.
Is deeply concerned about his/her patient's
welfare without becoming emotionally over
involved.
7.
Becomes too involved emotionally.
8.
Sits in judgment of patients.
9.
Is rigid and authoritarian.
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Comments for Tutor
This behaviour objective clearly involves giving a trainee responsibility for care - not always easy.
Clearly, patients and their families are the tutor's best guide to the trainee's success. Occasionally an
insensitive student will upset patients with resultant tutor reluctance to give the student more responsibility in
this area, when the student's need is greatest. We suggest that initially you pass the patient's comments on
to the trainee with a minimum of comment and continue to give the student responsibility, checking the
reactions of suitable patients.
DATA COLLECTION AND RECORDING
Acceptable behaviour:
1.
Takes a history whose comprehensiveness is clearly related to the needs of the patient and the
nature of the complaint.
2.
Utilizes to the full, patient's previous records and history.
3.
Is diligent in the search and acquisition of information from previous hospitals.
4.
Plans investigations carefully and economically.
5.
Information, diagnosis and treatment are clearly and concisely recorded.
6.
Records alterations in the patient's diagnostic or clinical status as it occurs.
Unacceptable behaviour:
1.
Follows no routine of history taking.
2.
Fails to use check lists.
3.
Fails to identify or elaborate patient leads.
4.
Fails to explore possible relevant psychological and social areas.
5.
Investigates in blunderbuss fashion without relation to diagnostic possibilities.
6.
Recorded information is sketchy and unsystematic.
Comment for Tutor
Chart review should reveal obvious defects and improvement after discussion. Occasionally, students differ
from tutors in what they consider to be their responsibility for taking histories. This area must be clearly
defined at the outset.
260
CLINICAL PROBLEM IN DELINEATION AND SOLUTION
Acceptable behaviour:
1.
Realizes the significance of unexpected data and seeks to interpret it.
2.
Understands the nature of probability diagnosis.
3.
Takes all data into account before making a decision.
4.
Tests all diagnostic hypotheses.
5.
Is flexible and wide ranging in his/her search for solutions.
Unacceptable behaviour:
1.
Fails to realize the implication of the data collected.
2.
Unable to interpret or ignores the unexpected item which does not fit.
3.
Thinking is rigid and not adequately related to the variations in different patient's lives.
4.
Fails to consider alternate solutions and does not diverge sufficiently before reaching a conclusion.
5.
Fails to consider the effect on diagnosis of basic variables such as commonness, age of patient and
duration of symptoms.
6.
Is influenced excessively by irrelevant factors.
Comments for Tutor
The average active primary care physician may make 6,000 diagnoses every year. To do this, he/she
manipulates a diagnostic vocabulary of approximately 475 diagnoses. The average PGY I trainee at the end
of his/her rotations has probably learned to manipulate 200 - 250 diagnoses. The natural history of the extra
225+ diagnoses may be learned from primary physicians or from specialists or other members of the health
care team. This is the most valuable skill you have to teach. If students require help in this area we suggest
"Towards Earlier Diagnosis in Primary Care" (5th Edition), K. Hodgkin, in the library.
EFFECTIVE USE OF CLINICAL JUDGEMENT
Acceptable behaviour:
1.
Is familiar with the uses and limits of any treatment that he/she uses.
2.
Is aware of side effects and dangers of any treatment that he/she prescribes.
261
3.
Simple inexpensive treatment is used first.
4.
Considers the patient's home situation.
5.
Is sensitive and flexible if the patient's home situation changes.
6.
He/she takes the patient into his/her confidence or fully explains what he/she is doing.
Unacceptable behaviour:
1.
More concerned with treatment than overall welfare of the patient.
2.
Gives inadequate explanations of disease process and treatment.
3.
Treatment techniques are rigid and inflexible or inappropriate for the patient's home.
4.
Favourite prescriptions are used without adequate thought.
5.
Needlessly complex or expensive treatments are used when simpler procedures are available.
Comments for Tutor
This is also an extremely valuable area for the trainee's learning and is often very personal to each tutor.
Please teach what you actually do. Thus, if you are prescribing antibiotics to children with respiratory
disease for geographical or social rather than bacteriological reasons, please teach and discuss your actual
reasons.
EMERGENCY CARE
262
Acceptable behaviour:
1.
Quickly assesses overall situation and
establishes priority.
2.
Is aware of delay and its
consequences.
3.
Able to obtain and organize the
assistance of others.
4.
Able to make and sustain decisions on
his/her own.
Unacceptable behaviour:
1.
Panics easily and loses time by
ineffective action.
2.
Becomes confused and flustered under
pressure.
3.
Unable to make or sustain decisions.
4.
Clinical data available is distorted to
justify lack of experience.
5.
Unable to delegate.
263
Comments for Tutor
This trainee will rarely be involved in many of these situations but despite this, try to involve him/her in as
many emergency situations as you can.
Please also involve the trainee in any telephone conversations with supportive consultants who are in any
way contacted when helping you to deal with emergency situations. The telephone relationship with
supportive obstetrician or pediatrician 100 or so miles away is a valuable and under stressed primary care
tool that we would like you to emphasize whenever possible.
He/she should also learn the consultant value of the social worker, public health nurse, priest or minister,
etc.
PREVENTATIVE CARE AND HEALTH EDUCATION
Acceptable behaviour:
1.
Uses his ordinary clinical practice to identify high risk group.
2.
Recognizes the need to assess preventative care in terms of cost, to government as well as patients.
3.
Recognizes the need to develop this area of primary care expertise.
4.
Keen to try out, evaluate and dissect new ideas in this field.
Unacceptable behaviour:
1.
Is only interested in curative medicine.
2.
Does not like to leave the hospital.
3.
Is reluctant to institute or evaluate new preventative measures.
Comments for Tutor
This is a difficult area to teach and most trainees are not involved in this area enough.
Perhaps the best and most useful persons to teach this are the public health nurse, social worker,
pediatrician and public health physician.
There is much to learn from paramedical personnel in this area.
264
CONTINUING CARE AND RESPONSIBILITY
Acceptable behaviour:
1.
Encourages patient to get back to
normal life either by pushing or
restraining.
2.
Reviews chronically ill patients
regularly and has a flexible approach
to long-term management.
3.
Able to delegate authority without
either patient contact or confidence.
4.
Able to stimulate and develop support
services for the chronically ill within
their own community.
Unacceptable behaviour:
1.
Loses interest after initial treatment.
2.
Fails to recognize the importance of
follow-up procedures and fails to
review chronically ill patients
regularly.
3.
Fails to check the accuracy of his/her
diagnostic predictions.
4.
Discouraged by slow progress or
deterioration of the patient.
5.
Evades or cannot deal with a situation
that is deteriorating or has a poor
prognosis.
6.
Fails to utilize paramedical help
appropriately.
265
Comments for Tutor
Continuity of care is difficult to teach in our PGY I program because trainees are never very long in one
situation.
We believe that a doctor doesn't really learn the realities of continuous care until he/she has been in his/her
own practice with his/her own patients for at least two years but you can, however, teach the trainee much
about continuity even in a short space.
We suggest that the following is helpful here:
a) In chart review always give your own summary of the appropriate social and family history.
b) Keeping good records and discussing the histories of patients who have been under your care for years.
c) Making the trainee give you family and social history summaries when he/she presents a problem to you.
RELATIONSHIPS WITH COLLEAGUES AND STAFF
Acceptable behaviour:
1.
Gets on well with people because he/she is conscious of their needs and tries to satisfy and
recognize their contribution.
2.
Able to play a secondary role in the health care team.
3.
Respects and utilizes the opinions and work of others.
4.
Seeks a second opinion where appropriate.
5.
Discusses mistakes with others.
6.
Creates an atmosphere of working with, not against others.
Unacceptable behaviour:
1.
Has difficulty with personal relations and lacks the ability to give and take instructions.
2.
Tactless and inconsiderate in relation to vital matters, e.g., workload, time off, pay.
3.
Unable to inspire confidence or cooperation with others.
4.
Unwilling to refer or consult with other physicians.
5.
Fails to support colleagues in their contact with patients.
266
Comments for Tutor
Involve the trainee in telephone consultations, practice meetings and local doctors' meetings. Also get
feedback about the trainee's relationship with other trainees, consultants and paramedicals.
If possible, check and discuss his/her letters of referral to consultants, laboratories and social agencies, etc.
THE ABILITY TO DEVELOP OBJECTIVE RESEARCH METHODS TO ANALYZE AND HANDLE THE
COMMON MEDICAL/SOCIAL PROBLEMS OF THE EVER CHANGING COMMUNITY IN WHICH THE
PHYSICIAN WORKS AND LIVES
Acceptable behaviour:
1.
Looks at an idea objectively and can formulate a null hypothesis related to it.
2.
Is interested in the objective comparison of two or more groups of clinical cases and is prepared to
accept that an attractive hypothesis may well be wrong.
3.
Can design a questionnaire which asks questions relevant to his/her hypothesis.
4.
Can think in terms of comparing the characteristics of two relevant objectively selected groups.
5.
Is aware of biases in him/herself and the material he/she selects.
6.
Is prepared to do literature search.
Unacceptable behaviour:
1.
Is not able to come down on a small area of interest.
2.
Tends to be more interested in the emotive and products of an idea and not in the objective
evaluation of it.
3.
Cannot understand the need to have independent criteria for selection of groups of cases for
comparison.
4.
Cannot maintain enthusiasm and interest in a particular idea.
5.
Produces many ideas in a half-formulated way.
Comments for Tutor
We have included this objective in the hope that interested tutors may involve the trainee in any research
which they do and also as a potential objective for the PGY I trainee who is going on to a residency.
THE ABILITY TO USE AND DEVELOP THE MANY TOOLS OR SERVICES THAT ARE AVAILABLE TO
THE PRIMARY PHYSICIAN
267
Acceptable behaviour:
1.
Selects procedures and community
services with care and relates them
clearly to his diagnostic hypothesis and
management plans.
2.
Considers annoyance and dangers of
procedures, etc., to patient. Is aware of
costs to both community and patient.
3.
Contacts personnel responsible for
service and finds out their views on the
correct use of the services that they
provide.
4.
Learns from the expert or professional
in charge of the service provided.
5.
Is interested in utilizing community
groups and other resources to develop
new services.
Unacceptable behaviour:
1.
Tends to use laboratories/hospitals in a
blunderbuss fashion without tailoring
his/her efforts to varying patient needs
or community resources.
2.
Is unaware of cost of procedures, etc.
3.
Does not provide adequate information
(history), etc. to the personnel in
charge of the service.
4.
Tends to give instructions instead of
requesting professional involved to use
his/her expertise to help solve the
patient's problems.
5.
Is not interested in starting new
services and regards this as being a
community or social worker's
responsibility.
268
Comments for Tutor
Where possible, get feedback from personnel in charge of services and check letters of referral; teach by
example. If you are successful in the above areas, your student will have a role model.
THE NEED FOR SELF-EVALUATION
Acceptable behaviour:
1.
Although may be initially threatened by self- evaluation, very soon comes to enjoy the process and
sets up further similar discussions, etc.
2.
Responds to a tutor's account of a mistake by recounting a similar one of his/her own.
3.
Can analyze interactions with difficult patients in terms of his/her own as well as the patient's
difficulties.
4.
Is aware of his/her own value judgement.
5.
Can laugh at him/herself.
6.
Is aware of his/her deficiencies in current medical knowledge and anxious to take remedial action in
important areas.
Unacceptable behaviour:
1.
Is clearly threatened by self-evaluation procedures such as discussion of mistakes in inadequacies,
role-play, etc.
2.
Does not discuss his/her mistakes.
3.
Is critical of colleagues or nurses without relating this to his/her own performance.
4.
Is critical of patients without looking into his/her own reactions.
5.
Is unaware that his/her own views may follow personal biases.
Comments for Tutor
An occasional session on your own mistakes is helpful and illuminating in this area, as in an account of how
you solve the dilemmas of continuing medical education for yourself.