Goals and Objectives

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Goals and Objectives

  1. 1. Revised 01/25/07 PEDIATRIC RADIOLOGY FELLOWSHIP GOALS AND OBJECTIVES St. Louis Children’s Hospital and the Mallinckrodt Institute of Radiology at the Washington University Medical Center Overall Goals These goals and objectives are provided to each MIR pediatric radiology fellow as a reference to be used throughout the pediatric fellowship year. These guidelines establish objectives for fellows who would like to pursue a career in pediatric radiology. The overall goal of the fellowship is to provide a one-year, supervised experience in the pediatric applications and interpretation of radiography, computed tomography, ultrasonography, angiography, interventional techniques, nuclear radiology, magnetic resonance, and any other imaging modality customarily included within the specialty of diagnostic radiology. The fellowship is structured to enhance substantially the fellow’s knowledge of the applications of all forms of diagnostic imaging to the unique clinical/pathophysiological problems of the newborn, infant, child, and adolescent. The fundamentals of radiobiology, radiological physics, and radiation protection as they relate to the infant, child, and adolescent are be reviewed during the pediatric radiology training experience. The fellowship provides direct and progressively responsible experience in pediatric imaging as they advance through training. This training must culminate in sufficiently independent responsibility for clinical decision making such that the program is assured that the graduating fellow has achieved the ability to execute sound clinical judgment, and practice competently and independently. The goals and objectives of each rotation are intended to ensure that the fellow achieves the six core competencies established by the ACGME: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice. Patient Care • Utilize Clinical Desktop for gathering pertinent patient information • Interview and examine patients when appropriate for accurate interpretation of radiological studies • Demonstrate knowledge of the levels of ionizing radiation related to specific imaging procedures and employ measures to minimize radiation dose to the patient. • Perform radiological examinations appropriately and safely, assuring that the correct examination is ordered and performed Medical Knowledge Page 1 of 10
  2. 2. Revised 01/25/07 • Identify normal/abnormal radiographs of the chest, heart, abdomen and skeleton including variable appearances at different ages • Evaluate chest radiographs of infants and children in intensive care units including neonatal respiratory distress and its complications, congenital heart disease, radiographic findings associated with sickle cell disease, the normal appearance of various catheters and devices including endotracheal tubes, central venous lines, chest tubes and extra-corporeal membrane oxygenation devices. • Evaluate the abdominal films of infants and children in intensive care units, to recognize: pneumoperitoneum, small bowel obstruction, necrotizing enterocolitis. • Identify pediatric orthopedic problems and their management, including: fractures, scoliosis, developmental dysplasia of the hips, Legg-Calve Perthes, hip effusions/septic hip, establish radiographic bone age • Become familiar with the plain radiographic findings in common pediatric conditions of ambulatory patients on chest, abdominal, and skeletal radiographs • With assistance from a Staff Radiologist, perform and evaluate fluoroscopic images of the gastrointestinal and genitourinary tract • With assistance from a Staff Radiologist or Staff Sonographer, perform and evaluate: cranial sonogram, renal sonogram, abdominal and pelvic sonograms, hip sonogram to evaluate for effusion • Evaluate computerized tomographic images of the chest, abdomen, pelvis and extremities. • Increase knowledge of pediatric plain radiographs and/or sonographic findings of children with emergent conditions including: pneumonia, pneumothorax, congestive heart failure , appendicitis, intussusception, non accidental trauma, fractures, hip effusions • Perform all fluoroscopic examinations except when complications are anticipated, with the consultation of the Staff Radiologist • Increase knowledge base regarding both common and uncommon pediatric conditions by plain radiograph, contrast studies and imaging, including some familiarity with the findings of pediatric body MR imaging • By the end of the rotation, have knowledge sufficient to pass the American Board of Radiology examination Interpersonal & Communication Skills • Provide direct communication to the referring physician or appropriate clinical personnel when interpretation of a study reveals an urgent or unexpected finding, and document this communication in the radiological report using specific date and time. • Make preliminary review of inpatient, outpatient, NICU and PICU films, and discuss findings with the Staff Radiologist, dictate, and confer with pediatric residents. • Participate in daily presentation of radiographic findings of NICU and/or PICU patients to clinical teams, and relay any radiologic recommendations Page 2 of 10
  3. 3. Revised 01/25/07 • Review plain radiographs and be able to make recommendations for further evaluation with sonogram, contrast studies or CT with pediatric house officers Professionalism • Recognize limitations in personal knowledge and skills so as not to make decisions beyond the level of competence • Demonstrate altruism and compassion towards patients • Recognize limitations in personal skill and knowledge in order to consult with senior residents and staff when needed • Be capable of making independent decisions on routine issues to become prepared for night call • Be capable of making independent decisions Practice-Based Learning and Improvement • Learn to present cases at daily morning teaching conference • Prepare an end-of-rotation follow-up conference Systems-Based Practice • Become aware of the basic necessities for coding and billing, including: • Ensuring there is a requisition from the doctor’s office, • Providing accurate and sufficient information within the radiological report to support appropriate ICD-9 coding Each fellow performs no fewer than 7000 pediatric radiological examinations per year per fellow. In the fellowship, each pediatric radiology fellow will perform at a minimum: 300 fluoroscopic procedures 300 ultrasound examinations 200 body imaging (CT/MR) examinations Each pediatric radiology fellow will perform a minimum number of specialized procedures as follows: 50 pediatric nuclear radiology studies 200 neuroimaging studies 25 vascular/interventional studies Rotation Structure Fellows will be given a core curriculum consisting of weekly rotations on the following services: A. Reading Room and Emergency Radiology B. Fluoroscopy C. Ultrasound D. Computed Tomography E. Magnetic Resonance Imaging F. Pediatric Neuroradiology Page 3 of 10
  4. 4. Revised 01/25/07 G. Interventional Radiology H. Nuclear Medicine A. Reading Room and Emergency Radiology Goal: Each fellow is expected to achieve competency in interpretation of diagnostic pediatric radiology examinations. Expectations: 1. Preview: the fellow will preview films prior to formal review with the staff and, when possible, help the resident to prepare for staff readout. 2. Dictation: the fellows dictate the cases that s/he has previewed with the attending. 3. The fellows will review, edit and sign their dictations prior to staff review of reports. 4. The fellow will review 7000 pediatric radiological examinations during the year. 5. The fellow will contribute cases with lasting educational value to the digital teaching file. 6. The fellow will fill out a monthly summary sheet documenting the number and type of radiology examinations performed. B. Fluoroscopy Goal: Each fellow is expected to achieve competency in fluoroscopically-guided pediatric procedures. Specifically, each fellow is expected to perform at least 300 fluoroscopic procedures. Expectations: 1. Consents: when appropriate, the consent of patients for image-guided fluoroscopic procedures will be the duty of the fellow. Attempt must be made to obtain consent before the scheduled time of the procedure. 2. Procedures: fellows are primarily responsible for performing fluoroscopically-guided procedures. The fellows will assist in teaching residents the essential aspects of fluoroscopically guided procedures. 3. Preview: the fellow will be responsible for previewing studies prior to formal review with the staff. This includes reviewing old studies in the PACS system and old reports from the RIS system. 4. Dictation: fellows have primary dictation responsibilities for the fluoroscopically guided procedures they perform. Residents may dictate the cases in which they participate. 5. The fellows will review, edit and sign their dictations prior to staff review of reports. 6. Conference Coverage. Fellows are responsible for covering all conferences, with the attending radiologist present. 7. The fellow will fill out a monthly summary sheet documenting the number and type of fluoroscopy procedures performed and conferences attended. Page 4 of 10
  5. 5. Revised 01/25/07 C. Ultrasound Goal: Each fellow is expected to achieve competency in interpretation ultrasound studies. Specifically, each fellow is expected to perform at least 300 ultrasound examinations Expectations: 1. Procedures: when appropriate, the fellow should participate in ultrasound scanning. 2. Preview: the fellow will be responsible for previewing studies prior to formal review with the staff. This includes reviewing old studies in the PACS system and old reports from the RIS system. 3. Dictation: fellows have primary dictation responsibilities for the examinations they perform. Residents may dictate the cases in which they participate. 4. The fellows will review, edit and sign their dictations prior to staff review of reports. 5. The fellow will fill out a monthly summary sheet documenting the number and type of ultrasound examinations performed. D & E. Computed Tomography and Magnetic Resonance Imaging Goal: Each fellow is expected to achieve competency in interpretation of pediatric CT and MRI studies. Specifically, each fellow is expected to perform at least 200 body imaging (CT/MR) examinations Expectations: 1. Protocols: the fellow will supervise the resident with selection of appropriate CT and MR protocols. The fellow must be available should the technologist request that an examination be reviewed for completeness. 2. Preview: the fellow will be responsible for previewing studies prior to formal review with the staff. This includes reviewing old studies from the PACS and old reports from the RIS. 3. Dictation: fellows and residents will equally share dictation responsibilities. When a junior resident is on service, the fellow will assume a greater share of the dictations. 4. The fellows will review, edit and sign their dictations prior to staff review of reports. 5. The fellow should be available by pager for protocol questions and consultations during the noon hour. 6. The fellow will fill out a monthly summary sheet documenting the number and type of CT and MRI examinations performed. F. Pediatric Neuroradiology Goal: Each fellow is expected to achieve competency in reading images on the neuroradiology service at St. Louis Children’s Hospital. Specifically, each fellow is expected to perform at least 200 neuroimaging studies. Page 5 of 10
  6. 6. Revised 01/25/07 Expectations: 1. Protocols: the fellow will supervise residents with selection of appropriate neuroradiology imaging protocols throughout the day and before leaving in the evening. 2. Preview: the fellow will be responsible for previewing studies prior to formal review with the staff. This includes reviewing old studies in the PACS and old reports from the RIS. 3. Dictation: the fellow and resident will share equally dictation responsibilities. When a junior resident is on service, the fellow will assume a greater share of the dictations. 4. Noon: the fellow will be available by pager for consultation and protocol questions between 12 noon and 1:00 pm. 5. The fellow will compile a monthly summary sheet listing the number of pediatric neuroradiology exams interpreted. G. Interventional Goal: Each fellow is expected to achieve competency in reading Interventional images. Specifically, each fellow is expected to perform at least 25 vascular/interventional studies. Expectations: 1. Consents: the consent of patients for interventional procedures will be the duty of the fellow. Attempt must be made to obtain consent before the scheduled time of the procedure. 2. Procedures: fellows are primarily responsible for performing interventional procedures. The fellows will assist in the teaching residents the essential aspects of interventional procedures. 3. Preview: the fellow will be responsible for previewing studies prior to formal review with the staff. This includes reviewing old studies in the PACS system and old reports from the RIS system. 4. Dictation: fellows have primary dictation responsibilities for the Interventional procedures they perform. Residents may dictate the cases in which they participate. 5. The fellows will review, edit and sign their dictations prior to staff review of reports. 6. The fellow will compile a monthly summary sheet listing the number of interventional exams interpreted each week. H. Nuclear Medicine Goal: Each fellow is expected to achieve competency in reading nuclear radiology studies. Specifically, each fellow is expected to perform at least 50 pediatric nuclear radiology studies Expectations: 1. Procedures: fellows are primarily responsible for supervising image acquisition. The fellows will assist in the teaching residents the essential aspects of nuclear radiology. Page 6 of 10
  7. 7. Revised 01/25/07 2. Preview: the fellow will be responsible for previewing studies prior to formal review with the staff. This includes reviewing old studies in the PACS system and old reports from the RIS system. 3. Dictation: fellows have primary dictation responsibilities for the nuclear radiology studies they perform. Residents may dictate the cases in which they participate. 4. The fellows will review, edit and sign their dictations prior to staff review of reports. 5. The fellow will compile a monthly summary sheet listing the number of nuclear radiology exams interpreted each week. b. The educational curriculum must include a didactic and clinical component (experience) including self instruction, self evaluation, teaching and research activities. The pediatric resident/fellow must also be instructed in the risks and benefits of pediatric sedation including an understanding of the physicians role in the monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Self instruction, self evaluation, teaching and research activities are provided through our follow-up conferences, cases, and presentations. Research is on-going. Pediatric sedation procedures at St. Louis Children’s Hospital are scheduled and performed in conjunction with nurse anesthetists and anesthesiologists. c & d. Program Director must establish monthly journal club and research conferences in this training program. The resident/fellow should participate in clinical, basic biomedical or health services research projects and submit at least one scientific paper or exhibit to a regional or national meeting. The resident/fellows should also participate in the quality improvement program of the department. A joint journal club and research conference has been established to meet monthly. The Program Director, Section Head, and fellow, as well as any other interested pediatric radiology staff, will attend this conference. The fellow will critique and discuss a relative selected paper and their research projects will be assessed and reviewed. 1. Evaluations a. Program specific policies for resident/fellow formal evaluation on the general competencies using at least 2 tools per competency evaluation. The resident/fellow must have formal feedback quarterly. Evaluation Criteria and Forms Goal: Page 7 of 10
  8. 8. Revised 01/25/07 To provide a timely, effective review and constructive criticism of each fellow’s performance with the goal of helping the fellow to achieve the six core competencies as a pediatric radiologist. Expectation: To document that the fellow attains competence in the six core competencies and to affirm that the fellow is able to practice competently and independently. • The staff will complete monthly evaluations of the fellows’ performance with regards to the six core competencies. • Each fellow will meet with the program director quarterly to discuss the monthly staff evaluations. This quarterly review will explicitly address the progress that the fellow is making toward achieving the six core competencies. The fellow is encouraged to provide feedback on the training program at this time. • The program director will provide a summary evaluation for each fellow that explicitly addresses whether the fellow has achieved the six core competencies. • The fellow will be asked to complete anonymous evaluation of the faculty and training program at the end of the 1-year training program. The Six Core Competencies are: PATIENT CARE Definition: Provide patient care through safe, efficient, appropriately utilized, quality-controlled diagnostic and/or interventional radiology techniques and effectively communicate results to the referring physician and/or other appropriate individuals in a timely manner. Assessment: 1. Global faculty evaluation (to include evaluation of knowledge about safety issues such as radiation dose, MRI safety, correct patient-exam-site verification, use of standard abbreviations) 2. Case/procedure logs (to be included in the fellow’s learning portfolio) 3. Direct observation of selected procedures and other critical processes (such as obtaining informed consent) 4. 360 degree evaluations 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. Assessment: 1. Global faculty evaluation (which includes the 6 competencies) 2. Resident learning portfolio (including documentation of conferences attended, courses attended, self-assessment modules completed, etc.) 3. Literature Review to evaluate skills in accessing, interpreting and applying best evidence in the radiology literature to patient care. Page 8 of 10
  9. 9. Revised 01/25/07 PRACTICE-BASED LEARNING AND IMPROVEMENT Definition: Involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care. Assessment: 1. Global faculty evaluation (which includes the 6 competencies) 2. Resident learning portfolio (including presentations, teaching files and case conferences). 3. Direct observation of clinical research and literature evaluation. INTERPERSONAL AND COMMUNICATIONS SKILLS Definition: Results in the effective exchange of information and collaboration with patients, their families, and other health professionals; Assessment: 1. Global faculty evaluation (which includes the 6 competencies) 2. Direct observation of selected procedures and other critical processes (such as obtaining informed consent). 3. 360 degree evaluations. PROFESSIONALISM Definition: Commit to high standards of professional conduct, demonstrating altruism, compassion, honesty and integrity. Follow principles of ethics and confidentiality and consider religious, ethnic, gender, educational and other differences in interacting with patients and other members of the health care team Assessment: 1. Global faculty evaluation 2. 360 degree evaluations 3. Verify status of medical license, if appropriate 4. Documentation of compliance with institutional and departmental policies (e.g., conference attendance, HIPPA, JCAHO, dress code) 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 healthcare system. Consult with other healthcare professionals, and educate healthcare consumers, regarding the most appropriate utilization of imaging resources Assessment: 1. Global faculty evaluation 2. Documentation of fellow participation in analysis of systems-based problem Page 9 of 10
  10. 10. Revised 01/25/07 3. Fellow learning portfolio (to include documentation of active participation in multi-disciplinary conferences) b. Faculty evaluations by resident/fellow must include an annual written anonymous confidential evaluation of faculty. With only 1 or 2 resident/fellows, it is suggested evaluations by the core radiology residents rotating on pediatrics and the pediatric resident/fellow complete a computerized questionnaire of the pediatric faculty with results collated and provided the Program and Division Directors annually. The fellow will attend the monthly exit conference for the rotating residents. To maintain written anonymous confidentiality for our single fellow, all residents will complete a faculty evaluation form. These monthly evaluation forms will be reviewed quarterly by the faculty. c. Program must be evaluated annually systematically. A program (education) committee consisting of program personnel (program director, representative faculty and at least one resident/fellow) must review the program goals and objectives and their effectiveness. The committee must take into consideration, written comments of faculty, the Internal Review report, resident/fellows and radiology residents confidential written evaluations. Program should use resident/fellow performance and outcome assessment in evaluation of the program effectiveness. Plans of action and discussions approved by the faculty must be documented in minutes of the meeting and a copy of the new forms used for resident/fellow, faculty and program evaluations. The pediatric radiology program will be evaluated annually. A committee consisting of our Program Director, Chief of the Section, and the fellow will review the program goals and objectives and their effectiveness. The committee will utilize written comments of faculty, the Internal Review report, and the fellow/residents confidential written evaluation. Fellow performance and outcome assessment will help in the evaluation of the program effectiveness. Page 10 of 10

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