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Specific skills to be acquired during this rotation:
Specific skills to be acquired during this rotation:
Specific skills to be acquired during this rotation:
Specific skills to be acquired during this rotation:
Specific skills to be acquired during this rotation:
Specific skills to be acquired during this rotation:
Specific skills to be acquired during this rotation:
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Specific skills to be acquired during this rotation:

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  1. Rotation Description for Body CT (First Rotation) I. Patient Care Definition: provide patient care through safe, efficient, appropriately utilized, quality- controlled diagnostic and/or interventional techniques and effectively communicate results to the referring physician and/or other appropriate individuals in a timely. Specific skills to be acquired during this rotation: 1. Review history of the patient for whom a CT examination has been ordered and collect pertinent information to determine the appropriate imaging evaluation for the clinical question. 2. Learn to triage and determine the time-frame to perform studies on multiple patients with different medical acuity. 3. Retrieve prior studies the patient has had performed. 4. Understand the multitude of CT protocols to protocol correctly routine indications for examinations of the abdomen and pelvis. Particularly be familiar with the indications and specifics for CT Urography, CT Enterography including that for appendicitis, GI and GU Trauma CT, Liver Mass CT, CT Pulmonary Angiography and Aortography. 5. Interpret normal abdominal and pelvic CT examinations and acute pathology, particularly life-threatening findings. 6. Be able to communicate results effectively to clinicians under the supervision of staff initially and then independently after the study has been discussed with faculty. Particularly be able to provide emergent preliminary results. Education: 1. Introduction to the PACS workstation is part of the introductory course for first year residents including a hands-on session. One-on-one help from residents and faculty with PACS during readouts. 2. Didactic lecture on CT protocols, use of contrast agents, and the recognition and treatment of contrast reactions are provided as part of the introductory course for first year residents. Attending staff is available for consultation though-out the rotation to protocol cases and there are protocol manuals for review. 3. Observation of and one-on-one instruction by senior resident and faculty interacting with clinicians and patients to obtain the information needed to determine and perform the proper exam. Subsequent performance by the resident under direct observation by faculty. 4. Observation of and one-on-one instruction by senior resident and faculty interacting with clinicians to communicate results. Subsequent performance by the resident under direct observation by faculty. 5. Observation of and one-on-one instruction by senior resident and faculty dealing with contrast reactions. Subsequent participation by the resident under observation. 6. Practical experience in recognizing normal anatomy and abnormal findings during daily readout of cases with faculty members. Learn to synthesize findings and provide a differential.
  2. Practice Performance Measurements: 1. Global faculty evaluation 2. 360 degree evaluation. 3. Resident learning portfolio: Teaching file cases collected throughout the rotation and chiefs’ rounds cases will be included in the resident’s portfolio. II. Medical Knowledge Definition: Engage in continuous learning using up to date evidence and apply appropriate state of the art diagnostic and/or interventional radiology techniques to meet the imaging needs of patients, referring physicians and the health care system. Specific skills to be acquired during this rotation: 1. Understand the basic physics of CT, how images are obtained and processed, and the radiation doses with different CT protocols. 2. Understand window and level setting used to evaluate different organs properly. Use of multiphase imaging and reformatted images with cross referencing to evaluate different organs properly. 3. Understand CT attenuation numbers and their interpretation. Problems with pseudoenhancement. 4. Learn indications and contraindications for oral contrast agents and ionic and non- ionic intravenous contrast media, the premedication protocol used in patients with known allergy to intravenous contrast and the management of contrast reactions. 5. Learn the normal and abnormal distribution of contrast agents, particularly as applies to arterial and venous phases of imaging. 6. Learn cross sectional anatomy of the chest, abdomen, and pelvis including the entire gastrointestinal tract, genitourinary system, peritoneal and retroperitoneal spaces, omentum and mesentery, vascular anatomy and lymphatic drainage. 7. Understand normal physiology and pathology of the gastrointestinal and genitourinary systems and how this relates to imaging. 8. Recognize imaging abnormalities and synthesize findings with the clinical information to arrive at a sound differential diagnosis. The areas of focus include: A. Acute disease processes, including appendicitis, diverticulitis, pancreatitis, cholecystitis, abscess, perforated viscus, bowel obstruction, bowel ischemia and volvulus, urolithiasis, pyelonephritis, pyonephrosis and renal abscess, gastrointestinal and genitourinary trauma. B. Normal and abnormal postoperative appearance of the abdomen and pelvis including abscess, anastomotic leak, vascular complication, and adjacent organ injury. C. Appearance of neoplastic processes in the organ systems of the gastrointestinal and genitourinary systems and the other organs of the chest, abdomen, and pelvis. Education: 1. Didactic lectures on acute abdominal disease processes are provided annually. 2. Didactic lectures on operative procedures and postoperative complications and neoplastic processes are provided throughout the residency.
  3. 3. Daily reading assignments depending on cases encountered during the day for mini- presentation and/or discussion the following day. 4. Prepare teaching file cases designated by staff and enter them into the departmental teaching file. 5. Read textbooks and journal articles (see list of Required and Recommended Readings). Practice Performance Measurements: 1. Global faculty evaluation. 2. 360 degree evaluation. 3. Yearly objective tests: ABR in-training examination, ABR written examination, Abdominal CT component of BIDMC EU Readiness Test. III. Practice-based Learning and Improvement Definition: Participation in evaluation of one’s personal practice utilizing scientific evidence, “best practices” and self-assessment programs in order to optimize patient care through lifelong learning. Specific skills to be acquired during this rotation: 1. Perform practice-based improvement in cognitive knowledge, observational skills, synthesizing clinical/laboratory/radiological data, and formulating an impression and plan. 2. Demonstrate knowledge of and apply principles of evidence-based medicine to daily practice. 3. Use multiple sources, including -- but not limited to -- information technology, to support patient care decisions. 4. Demonstrate an ability to distinguish between the quality of various information sources (e.g. informal website versus original research in peer-reviewed journal). 5. Learn to identify images of suboptimal quality that require placement into the departmental QA database. Learn to identify image interpretation errors that require placement into the departmental QA database. Education: 1. Residents will participate in the section’s monthly QA meeting, including preparation and presentation of cases. 2. Residents participate in weekly interesting case conference which includes discussion on current literature, evidence-based medicine, and best practices. Resident’s may also present at Chief’s Rounds which includes discussion on current literature, evidence- based medicine, and best practices. 3. Residents participate in monthly journal club discussing systems based practice. 4. During read-out, residents will receive direct instructions from faculty on how to use multiple information sources to support patient care decisions and optimize practices. Practice Performance Measurements: 1. Global faculty evaluation 2. 360 degree evaluation. 3. Resident learning portfolio: Documentation of entering teaching file cases and presentation at Chief’s Rounds. Documentation of participation in departmental QI/QA.
  4. Interpersonal and Communication Skills Definition: Communicate effectively with patients, colleagues, referring physicians and their members of the health care team concerning imaging appropriateness criteria, informed consent, safety issues and results if imaging tests or procedures Specific skills to be acquired during this rotation: 1. Learn the HIPAA regulations on how they are practiced. 2. Create clear, concise, and informative written radiological reports, including pertinent findings and negatives, a summary and synthesis with differential, and a plan. 3. By observing and then performing under supervision, learn how to communicate with the referring physician about the indication for the study and, if applicable, about recommendations for change in the type of examination to be performed to answer best the clinical question. 4. By observing and then performing under supervision, learn how to communicate with the technologist about any special patient needs such as contraindications to intravenous contrast or additional CT series that should be obtained to characterize pathology optimally. 5. By observing and then performing under supervision, learn how to communicate directly with referring physicians or appropriate clinical personnel when interpretation reveals an urgent or unexpected finding and document this communication -- with specifics regarding person contacted, method of contact, and time of contact - in the written report. This includes becoming familiar with and complying with the Department policies on urgent notification. Education 1. Observation of and one-on-one instruction by senior resident and faculty on interacting with clinicians and patients to obtain the information needed to determine and perform the proper exam. Subsequent performance by the resident under direct observation by faculty. 2. Observation of and one-on-one instruction by senior resident and faculty on interacting with clinicians to communicate results and develop a care plan. Subsequent performance by the resident under direct observation by faculty. 3. Resident serves as a contact person for technologists with questions about protocols, wet reads, or image quality issues that can then be discussed with senior residents and/or faculty. 4. Resident gains practical experience in dictating radiological reports. Reports are corrected at the time of attending sign out and necessary revisions are discussed. 5. Communication issues are discussed regularly in the abdominal QA meeting and suggestions for optimal communication for each QA case is given. Practice Performance Measurements 1. Global Faculty evaluation 2. 360 degree evaluation. 3. Evaluation of quality of reports Professionalism
  5. Definition: Commit to high standards of professional conduct, demonstrating altruism, compassion, honesty and integrity. Follow principles of ethics and confidentiality and consider religious, ethic, gender, educational and other differences in interacting with patients and other members of the health care team. Specific skills to be acquired during this rotation: 1. Demonstrate positive work habits, including punctuality and professional appearance. 2. Demonstrate altruism and compassion towards patients and staff 3. Perform responsibilities at the highest level. 4. Function as an effective team member, including identifying section needs and pitching in to help where needed (e.g. reading cases, interacting with patients and staff, preparing support materials) 5. Dictate cases and correct transcribed dictations in a timely and accurate fashion, including use of recommended report templates. 6. Request permission in advance from section chief regarding requests for time away from the clinical work day. Education 1. Professional conduct will be demonstrated throughout this rotation by role-modeling of the attending staff. Residents will be able to observe interactions of attending staff with patients, technologists and referring clinicians. 2. Didactic lectures on professionalism are provided as part of a hospital wide curriculum. Practice Performance Measurements 1. Global Faculty evaluation. 2. 360 degree evaluation. System-based Practice Definition: Understand how the components of the local and national healthcare system function interdependently and how changes to improve the system involve group and individual efforts. Optimize coordination of patient care both within one’s own practice and within the health care system. Consult with other healthcare professionals, and educate consumers, regarding the most appropriate utilization of imaging resources. Specific skills to be acquired during this rotation: 1. Learn appropriateness criteria for body CT imaging studies. 2. Learn how to review the literature to develop knowledge of evidence-based utilization of body CT and best practices for cost-effective utilization of imaging resources. 3. Learn how to optimize patient care by consulting with other health care providers to choose the most effective and efficient imaging strategy to maximize diagnostic yield while minimizing risk to the patient as well as cost. Education 1. Attendance and active participation in abdominal imaging conference and multidisciplinary conferences (GI and GU oncology conference), where there is
  6. discussion of the imaging evaluation of, as well as the most appropriate and cost- effective methods for diagnosing, specific gastrointestinal and genitourinary disorders. 2. Residents will observe senior residents and faculty consult with physicians requiring radiological aid in the coordination of patient care. 3. Residents will observe senior residents and faculty educate clinicians regarding the most appropriate utilization of imaging resources for their patient. 4. Systematic review of appropriateness literature (current American College of Radiology appropriateness criteria) in order to develop knowledge of evidence- based indications for body CT. 5. Participation in monthly section QA meeting where application of national appropriateness criteria and cost-effective management in the health care system is discussed. Practice Performance Measurements 1. Global Faculty evaluation 2. 360 degree evaluation. 3. Resident Learning portfolio: A. Documentation of active participation in multidisciplinary conferences (GI oncology conference, GU conference) B. Documentation of resident participation in analysis of systems-based practice as part of monthly abdominal QA meeting Reading List Required: Webb, Brant and Helms: Fundamentals of Body CT. (chapters on abdomen and pelvis) Supplemental: (In particular chapters on normal anatomy and disease processes listed above) N. Reed Dunnick, Carl M Sandler, Jeffrey H Newhouse, E. Stephen Amis. Textbook of Uroradiology, 3rd Ed. Lippincott Williams & Wilkins, Philadelphia, 2001 R.M. Gore and M.S. Levine. Textbook of Gastrointestinal Radiology, 2nd ed. W.B. Saunders, 2000, Joseph T Lee, Stuart S Sagel, Robert J Stanley, Jay P Heiken. Computed Body Tomography with MRI Correlation, 2nd ed. Lippincott, Williams and Wilkins, 2005. Morton A. Meyers, S.R. Baker, A.S. Berne, et al. Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy, 5th ed. Springer, 2000.
  7. discussion of the imaging evaluation of, as well as the most appropriate and cost- effective methods for diagnosing, specific gastrointestinal and genitourinary disorders. 2. Residents will observe senior residents and faculty consult with physicians requiring radiological aid in the coordination of patient care. 3. Residents will observe senior residents and faculty educate clinicians regarding the most appropriate utilization of imaging resources for their patient. 4. Systematic review of appropriateness literature (current American College of Radiology appropriateness criteria) in order to develop knowledge of evidence- based indications for body CT. 5. Participation in monthly section QA meeting where application of national appropriateness criteria and cost-effective management in the health care system is discussed. Practice Performance Measurements 1. Global Faculty evaluation 2. 360 degree evaluation. 3. Resident Learning portfolio: A. Documentation of active participation in multidisciplinary conferences (GI oncology conference, GU conference) B. Documentation of resident participation in analysis of systems-based practice as part of monthly abdominal QA meeting Reading List Required: Webb, Brant and Helms: Fundamentals of Body CT. (chapters on abdomen and pelvis) Supplemental: (In particular chapters on normal anatomy and disease processes listed above) N. Reed Dunnick, Carl M Sandler, Jeffrey H Newhouse, E. Stephen Amis. Textbook of Uroradiology, 3rd Ed. Lippincott Williams & Wilkins, Philadelphia, 2001 R.M. Gore and M.S. Levine. Textbook of Gastrointestinal Radiology, 2nd ed. W.B. Saunders, 2000, Joseph T Lee, Stuart S Sagel, Robert J Stanley, Jay P Heiken. Computed Body Tomography with MRI Correlation, 2nd ed. Lippincott, Williams and Wilkins, 2005. Morton A. Meyers, S.R. Baker, A.S. Berne, et al. Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy, 5th ed. Springer, 2000.

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