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The Nuclear Radiology Milestone Project A Joint Initiative of The Accreditation Council for Graduate Medical Education and The American Board of Radiology February 2014 The Nuclear Radiology Milestone Project The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGMEaccredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context. i Nuclear Radiology Milestones Chair: Lawrence P. Davis, MD Working Group Advisory Group Manuel L. Brown, MD Gary Becker, MD Laura Edgar, EdD, CAE Louis Ling, MD Milton J. Guiberteau, MD Kay H. Vydareny, MD Petra J. Lewis, MD M. Elizabeth Oates, MD Umesh Oza, MD ii Milestone Reporting This document presents milestones designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship through graduation. In the initial years of implementation, the Review Committee will examine milestone performance data for each program’s fellows as one element in the Next Accreditation System (NAS) to determine whether fellows overall are progressing. For each period, review and reporting will involve selecting milestone levels that best describe a fellow’s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert in the subspecialty. Selection of a level implies that the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v). Level 1: The fellow demonstrates milestones expected of an incoming fellow. Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level. Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for fellowship. Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is designed as the graduation target. Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional fellows will reach this level. iii Additional Notes Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the fellowship program director. Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions. Examples are provided with some milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element. Some milestone descriptions include statements about performing independently. These activities must occur in conformity to the ACGME supervision guidelines, as well as institutional and program policies. For example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight. Answers to Frequently Asked Questions about the Next Accreditation System and Milestones are posted on the Next Accreditation System section of the ACGME website. Radiology Subspecialty Assessment tools: End-of-Rotation Global Assessment Direct observation and feedback Reading out with resident Review of reports Rate of major discrepancies Self-Assessment and Reflections/Portfolio OSCE/simulation Completion of institutional safety modules, BCLS/ACLS Case/Procedure Logs, including complications Multi-Source Evaluations iv The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be indicated by selecting the level of milestones that best describes that fellow’s performance in relation to those milestones. Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated. Selecting a response box on the line in between levels indicates that milestones in lower levels have been demonstrated as well as some milestones in the higher level(s). v Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Patient and Personnel Safety (Diagnostic and Procedural) — Patient Care 1 Level 1 Knows basic radiation protection concepts (e.g., As Low As Reasonably Achievable [ALARA]) Level 2 Uniformly practices ALARA principles for self, staff members, patients, families, and public Knows basic considerations for imaging females of childbearing age, and those who are pregnant/breastfeeding Understands radiation dose concerns as related to radionuclide imaging, including hybrid imaging, and can explain risk/benefit Safely handles and administers radiopharmaceuticals Ensures that each patient receives the appropriate examination or therapy Recognizes and manages contrast reactions and infiltrations Treats common complications from administered nonradioactive pharmaceuticals (e.g., furosemide, morphine sulfate, captopril) Manages minor radioactive spills Comments: Level 3 Knows the comparative radiation exposures received by patients for common nuclear radiology examinations and procedures Level 4 Understands the management of dose limit exceptions to personnel or public from nuclear radiology examinations and therapeutic procedures Optimizes radiopharmaceutical dosages based on patient parameters (e.g., age, size, comorbidities, pregnancy, nursing) Knows the comparative radiation exposures received by patients for uncommon nuclear radiology examinations and procedures Knows the relative and absolute contraindications to diagnostic and nuclear radiology therapeutic examinations (e.g., aortic stenosis, exercise stress) Reduces patient radiation exposure through choice of examination and protocol optimization (e.g., hydration/ voiding) Understands and adopts the concepts of Image Wisely ® and Image Gently ® Level 5 Teaches patient and personnel radiation safety Implements new safety procedures and quality control measures impacting patient care Understands the prevention and management of therapeutic radiopharmaceutical infiltrations Not yet achieved Level 1 “Common” and “uncommon” to be defined by each program Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 1 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Diagnostic Examinations: Patient Selection, Preparation, Examination Supervision, and Image Interpretation — Patient Care 2 Level 1 Evaluates imaging requests and patient information, and reviews previous examinations Proposes appropriate examinations for common conditions/clinical presentations Level 2 Selects and tailors protocols of common examinations according to patient information Recommends appropriate patient preparation (e.g., diet, medication) Accurately makes core observations/interpretations and formulates appropriate differential Accurately makes core diagnoses for uncommon findings observations/interpretations on common examinations and formulates appropriate differential diagnoses for Correlates nuclear imaging with common findings on anatomical imaging, and compares common examinations to previous examinations Is familiar with the range of cardiac stress methods and protocols Narrows the differential diagnosis and describes management options Recognizes the implications of the adequacy of cardiac stress on examination interpretation Comments: Level 3 Appropriately supervises adequacy and completeness of common examinations Makes accurate, efficient, and focused interpretations of uncommon examinations, including secondary findings Prioritizes differential diagnoses and recommends appropriate management Level 4 Selects and tailors protocols of uncommon examinations according to patient information Appropriately supervises adequacy and completeness of uncommon examinations and complex cases Makes subtle observations and suggests a single “best” diagnosis, when appropriate, on all examinations Level 5 Teaches diagnostic nuclear imaging to other learners Acts independently as a consultant on interdisciplinary teams Presents or publishes nuclear radiology research in peerreviewed media Integrates current literature and national practice guidelines into daily work Not yet achieved Level 1 “Common” and “uncommon” to be defined by each program Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 2 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET 131 Radionuclide Therapies: I for Benign and Malignant Disease, Parenteral Therapies – Patient Selection, Preparation, Evaluation, Monitoring, and Follow-up — Patient Care 3 Level 1 Knows indications/ contraindications for radioiodine therapy of benign and malignant thyroid diseases Level 2 Evaluates, selects, and prepares patients for radioiodine therapy, including obtaining consent, and performs the procedure Is familiar with radiation Communicates radiation safety precautions and safety precautions to patient, restrictions (e.g., isolation) family, caregivers, and hospital personnel Knows the indications/ contraindications for common parenteral radiopharmaceutical therapies Comments: Level 3 Selects and applies appropriate patient release criteria, and follows up with patient after radioiodine therapy Evaluates, selects, and prepares patients for common parenteral radiopharmaceutical therapies, including obtaining consent Level 4 Plans and performs radioiodine therapy in complicated clinical situations (e.g., renal failure, mentally or physically challenged patients) Performs common parenteral radiopharmaceutical therapies Level 5 Demonstrates knowledge of emerging therapeutic radiopharmaceuticals Acts independently as a consultant on interdisciplinary teams Teaches radiopharmaceutical therapy topics Publishes or presents on a radiopharmaceutical therapy topic Not yet achieved Level 1 “Common” and “uncommon” to be defined by each program Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 3 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Anatomy, Physiology, and Pathophysiology — Medical Knowledge 1 Level 1 Knows normal planar and cross-sectional anatomy Recognizes common anatomic variants and commonly-encountered pathology Knows normal physiology of adults and children Understands pathophysiology of common diseases Level 2 Understands physiologic basis for patient preparation protocols Recognizes and explains anatomic and functional radiopharmaceutical imaging findings of common diseases in adults and children based on knowledge of anatomy, physiology, and pathophysiology Level 3 Recognizes and explains correlative and hybrid imaging findings of common disease in adults and children based on knowledge of anatomy, physiology, and pathophysiology Level 4 Recognizes uncommon anatomic variants Recognizes and explains radiopharmaceutical, correlative, and hybrid imaging findings of complex and uncommon diseases in adults and children based on knowledge of anatomy, physiology, and pathophysiology Level 5 Teaches planar and crosssectional anatomy, physiology, and pathophysiology Understands physiologic basis for pharmacologic interventions and subsequent imaging findings Comments: Not yet achieved Level 1 “Common” and “uncommon” to be defined by each program Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 4 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Physics and Instrumentation — Medical Knowledge 2 Level 1 Knows basic nuclear radiology physics Has knowledge of basic instrumentation and functions of non-imaging devices (e.g., ionization chambers, well counters, survey meters, NaI probes) and imaging devices (e.g., gamma cameras, positron emission tomography/computed tomography (PET/CT) scanners, and other hybrid imaging systems) Level 2 Understands the mathematical principles of the use and measurement of radioactivity Understands basic image acquisition and image processing Recognizes common imaging artifacts and technical problems Demonstrates knowledge of routine instrument quality control tests Processes simple nuclear radiology examinations (e.g., renal scan) Comments: Level 3 Understands how to optimize image acquisition Understands image reconstruction methods Level 4 Recognizes and resolves common and uncommon instrumentation artifacts and other quality control issues Processes and optimizes more complex nuclear radiology examinations (e.g., multigated acquisition cardiac) Understands the comparative advantages and describes disadvantages of routinely used nuclear radiology instrumentation Understands how to operate a dose calibrator, survey meter, and thyroid probe Understands and describes comparative advantages and disadvantages of different image reconstruction methods Recognizes common abnormal quality control test results Level 5 Teaches nuclear radiology physics and instrumentation Presents or publishes physics or instrumentation-related research in peer-reviewed media Develops new quality control and/or imaging protocols Not yet achieved Level 1 “Common” and “uncommon” to be defined by each program Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 5 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Radiopharmaceuticals — Medical Knowledge 3 Level 1 Understands the tracer principle Knows the indications, physical properties, and expected biodistributions of commonly used diagnostic (e.g., Tc-99m) and therapeutic (e.g., I-131) radiopharmaceuticals Level 2 Recognizes normal variant and abnormal biodistributions of commonly used diagnostic and therapeutic radiopharmaceuticals Recognizes radiopharmaceutical quality control problems on images (e.g., free 99mTc) Knows basic radiopharmacy operations and routine quality control tests Level 3 Knows the indications, physical properties, and expected biodistributions of uncommonly used diagnostic (e.g., In-111 pentetreotide) and therapeutic (e.g., I-131 MIBG) radiopharmaceuticals Recognizes normal variant and abnormal biodistributions of uncommonly used diagnostic and therapeutic radiopharmaceuticals Level 4 Discusses emerging radiopharmaceuticals and other molecular imaging agents Level 5 Teaches radiopharmaceutical topics, including quality control Resolves radiopharmaceutical quality control problems Publishes or presents on a radiopharmaceutical topic Understands the elements of a radiopharmaceutical quality assurance program Aids in the development of new diagnostic and therapeutic radiopharmaceutical protocols Understands the implications of radiopharmaceutical quality control problems Comments: Not yet achieved Level 1 “Common” and “uncommon” to be defined by each program Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 6 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Regulatory Requirements — Systems-based Practice 1 Level 1 Demonstrates awareness of the Nuclear Regulatory Commission (NRC), pertinent state-specific agencies, and methods of accreditation Knows the purpose and functions of a nuclear radiology radiation safety program Level 2 Knows the basic NRC regulations and state-specific laws applying to radioactive materials use, storage, and disposal, the definition of Authorized User, and components of a written directive Understands the composition and function of the Radiation Safety Committee and the responsibilities of the Radiation Safety Officer Level 3 Applies appropriate laws and regulations to daily clinical scenarios in the nuclear radiology clinic/laboratory (e.g., receives packages, performs ambient surveys) Performs basic radiopharmaceutical quality control testing Level 4 Understands the appropriate rules and regulations required to function as a medical director of a nuclear radiology unit Is familiar with The Joint Commission, NRC, and state radiation safety inspection processes Level 5 Is capable of participating in a regulatory committee, such as the Radiation Use Committee (RUC) or Radiation Safety Committee (RSC) Serves as the point person during an inspection by The Joint Commission, NRC, or state radiation safety inspection team Knows how to disclose reportable or recordable incidents Comments: Not yet achieved Level 1 Copyright (c) Pending. 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The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 7 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Health Care Economics — Systems-based Practice 2 Level 1 Describes the technical and professional components of imaging costs in nuclear radiology Has a basic understanding of the advantages and disadvantages of different payment systems Comments: Level 2 Demonstrates knowledge of departmental cost-savings initiatives Creates reports that contain the elements necessary to support examination coding and billing compliance Level 3 Describes billing and coding problems of specific nuclear radiology examinations and procedures; recognizes and corrects incorrect coding Level 4 Understands the concept of national quality improvement financial incentives (e.g., Physician Quality Reporting System [PQRS]) Develops understanding of relative charges and reimbursement for common nuclear radiology examinations and procedures Knows the current reimbursement rules for highcost complex nuclear radiology procedures (e.g., flurodeoxyglucose [FDG], PET/CT, hybrid imaging) Has a basic understanding of the pre-certification process, radiology benefits managers, and structured computer-based order entry systems Has an advanced practical understanding of the precertification process, radiology benefits managers, and structured computer-based order entry systems Level 5 Has a basic understanding of current state and national health care policies and their implications Not yet achieved Level 1 Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 8 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Quality Improvement — Systems-based Practice 3 Level 1 Describes the departmental incident/occurrence reporting system Level 2 Describes nuclear radiology quality improvement initiatives Participates in the departmental incident/occurrence reporting system Comments: Level 3 Incorporates nuclear radiology quality improvement into clinical practice Works in inter-professional teams to enhance patient safety and improve patient care quality Level 4 Participates in identifying institutional operational gaps and implementing potential solutions Level 5 Leads a team in the design and implementation of a quality improvement project for the nuclear radiology program Routinely participates in institutional root cause analysis Not yet achieved Level 1 Copyright (c) Pending. 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The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 9 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Self-directed Learning — Practice-based Learning and Improvement 1 Level 1 Is aware of gaps in personal knowledge and experience; seeks help when appropriate Incorporates feedback from teachers, colleagues, and patients for selfimprovement Develops a personal learning plan Level 2 Seeks and incorporates feedback to improve performance Level 3 Demonstrates a balanced and accurate professional selfassessment Level 4 Develops an ongoing personal continuing education plan Level 5 Participates in a lifelong continuing education plan in the subspecialty Assesses and provides feedback to junior learners Investigates clinical outcomes, and identifies areas for continued improvement Regularly incorporates evidence-based information and current research into self-directed learning Develops an educational curriculum and/or assessment tools (e.g., resident evaluation tool) Shows evidence of reading current literature related to clinical topics Prepares and teaches residents/student conferences Selects evidence-based information to answer advanced clinical questions Selects evidence-based information to answer basic clinical questions Comments: Not yet achieved Level 1 Copyright (c) Pending. 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The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 10 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Scholarly Activity — Practice-based Learning and Improvement 2 Level 1 Demonstrates understanding of critical thinking skills and research design (e.g., journal club) Demonstrates knowledge of basic principles underlying the ethical conduct of research and the protection of human subjects Level 2 Critically reviews and interprets the literature, demonstrating the ability to identify study aims, hypotheses, design, and biases Initiates a focused scholarly activity Level 3 Applies the principles of ethics and good clinical practice to the protection of human subjects recruited to participate in research Maintains data safety and patient monitoring to ensure continued protection of human subjects Level 4 Demonstrates understanding of statistics and epidemiology in data analysis Completes and presents scholarly activity to peers for review and critique at the departmental or local/regional/national level Level 5 Independently plans and executes research project Applies for/obtains extramural funding for research study Submits research to peerreviewed journal and/or presents nationally Identifies a mentor and proposes a scholarly activity Comments: Not yet achieved Level 1 Copyright (c) Pending. 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The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 11 Version 2/2014 Individual — Professionalism 1 Level 1 Is an effective health care team member, promoting primacy of patient welfare, patient autonomy, and social justice THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Level 2 Seeks and incorporates feedback to improve professional behavior Level 3 Discusses individual professionalism issues with students and residents Level 4 Serves as a role model for individual professional behavior Level 5 Mentors others regarding professionalism and ethics Demonstrates the following professional behaviors: is truthful recognizes personal limitations and seeks help when appropriate recognizes personal impairment and seeks help when needed responds appropriately to constructive criticism places needs of patients before self maintains appropriate boundaries with patients, colleagues, and others exhibits tolerance and acceptance of diverse individuals and groups Comments: Levels 2-4: Maintains professional behavior as described in Level 1 Not yet achieved Level 1 Copyright (c) Pending. 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The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 12 Version 2/2014 Systems — Professionalism 2 Level 1 Is an effective health care team member who demonstrates the following professional behaviors: fulfills work-related responsibilities recognizes the importance and priority of patient care and advocates for patient interests maintains patient confidentiality fulfills Institutional and Program Requirements related to professionalism and ethics prepares for and attends required conferences THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Level 2 Identifies opportunities to improve professionalism in the workplace Level 3 Takes part in programs to improve clinical care and professional behavior Discusses system professionalism issues with students and residents Comments: Levels 2-4: Maintains professional behavior as described in Level 1 Level 4 Serves as a role model for system professionalism Is an effective health care team leader Level 5 Accepts leadership roles in institutional, regional, and/or national organizations to advance professionalism Not yet achieved Level 1 Copyright (c) Pending. 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The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 13 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Effective Communication with Patients, Families, and Caregivers — Interpersonal and Communication Skills 1 Level 1 Adheres to HIPAA and institutional confidentiality policies Exhibits basic communication skills and, with indirect supervision, can effectively communicate in nonstressful situations (e.g., normal results, acquiring patient history) Obtains informed consent for diagnostic procedures (e.g., pregnant patient, sentinel node injections) Comments: Level 2 Communicates more complex or difficult information (e.g., abnormal results, need for additional imaging) in straightforward cases Communicates with more challenging patients (e.g., cognitive impairment, anxiety, cultural differences, language barriers, low health literacy) under indirect supervision Level 3 Working with program faculty members, oversees and teaches more junior learners on how to communicate effectively with patients, families, caregivers, and staff members Under direct supervision, obtains informed consent for therapeutic procedures Level 4 Serves as a role model for effective and compassionate communication for more junior learners Level 5 Develops guidelines for communication within the department or institution Seeks leadership opportunities in regional or national professional organizations with regards to patient-centered communication Seeks leadership opportunities in the department or institution with regards to patientcentered communication Under direct supervision, communicates medical errors, complications, and adverse events Communicates medical errors, complications, and adverse events Under indirect supervision, obtains informed consent for therapeutic procedures Not yet achieved Level 1 Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Nuclear Radiology Milestones on a non-exclusive basis for educational purposes. 14 Version 2/2014 THE NUCLEAR RADIOLOGY MILESTONES: ACGME REPORT WORKSHEET Effective Communication with Members of the Health Care Team (Written and Oral) — Interpersonal and Communication Skills 2 Level 1 Adheres to HIPAA and institutional confidentiality policies Efficiently generates clear, accurate, and concise reports that do not need substantial faculty member corrections in most cases Communicates effectively and professionally in nonstressful situations Understands the institutional policy for transitions of care and hand-offs/hand-overs Communicates urgent, critical, and unexpected findings according to institutional policy, and in compliance with ACR guidelines Comments: Level 2 Efficiently generates clear, accurate, and concise reports that do not need substantial faculty member corrections in all cases Communicates effectively and professionally during more stressful situations (e.g., on call, busy day) Effectively manages transitions of care and handoffs/hand-overs Level 3 Generates tailored reports meeting the specific needs of the referring providers Level 4 Serves as a role model for effective professional communication Communicates effectively and professionally in all situations (e.g., during interpersonal or interdisciplinary conflicts) With faculty member supervision, helps to organize departmental and interdisciplinary teaching and/or patient care conferences Works with program faculty members to oversee and teach junior learners on how to communicate effectively and professionally Actively participates in departmental and interdisciplinary teaching and/or patient care conferences Seeks leadership opportunities in the department or institution with regards to health care team-centered communication Level 5 Develops and implements standardized report templates Resolves service issues effectively and professionally (e.g., delay in exam scheduling) Independently leads departmental and interdisciplinary teaching and/or patient care conferences Develops guidelines for written and oral communications for local or national use Seeks leadership opportunities in regional or national professional organizations with regards to health care team-centered communication Not yet achieved Level 1 Copyright (c) Pending. 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