GOALS &OBJECTIVES - SATIN



CanMeds Goals & Objectives- MNH

Table of Contents

1) Goals: 2

2) General Objectives – Junior Resident 3

Professional 3

Communicator 3

Collaborator 3

Leader 3

Health Advocate 3

Medical Expert 4

Rotation expectations 4

Specific Objectives 5

Junior Resident 5

Senior resident 5

Recommended books: 5

Rotation Responsibilities: 6

Clinical: 6

Teaching: 6

Rounds 6

Evaluation: 6

Expected Volumes 6

First time rotation: (FOUR WEEK ROTATION) 6

For Second Time Rotation: 6

3) Neuroradiology for Senior Residents 7

Goals: 7

Objectives 7

Professional 7

Communicator 7

Collaborator 8

Leader 8

Heath Advocate 8

Medical Expert 8

Specific Objectives 9

Recommended books: 10

Rotation Responsibilities: 10

Clinical: 10

Teaching: 10

Rounds 10

Evaluation: 10

First time rotation: (FOUR WEEK ROTATION) 10

For Second Time Rotation: 10

Goals:

The rotation at the MNI provides the junior resident with the opportunity to learn from a varied group of CNS pathologies. At the MNI the exposure to both diagnostic and neuroendovascular cases will help the resident to feel at ease with neuroradiology cases in a general radiology practice. The resident will be able to advise the clinician and patient on the potential uses of Neurointerventional procedures. The trainee will feel comfortable consulting with Neurologists, Neurosurgeons and other clinicians. In addition, the resident will acquire expertise in order to carry out diagnostic procedures such as myelograms and diagnostic lumbar punctures

General Objectives – Junior Resident

Professional

▪ The rotation at the MNH intends to help the resident consolidate a practice based on respect and honorableness toward patients, colleagues, and staff of the Neuroradiology service.

▪ Junior residents are expected:

▪ To keep confidentiality of patient’s files.

▪ To embrace cultural differences and to being able to discuss relevant clinical information with peers, staff and health allied personal.

▪ To accept feedback of their performance.

▪ To arrive on time to activities and to leave once the activities are finished. To ensure that any request for medical attention to patients required during his/her presence in the radiology department is promptly answered.

Communicator

▪ The rotation at the MNI will provide the junior resident with the elements to generate a clear neuroradiological report taking into consideration the previous imaging and present clinical condition of patient. This report should address the query of the referring physician, and will recommend an imaging modality of choice to guide further investigation.

▪ During the rotation the junior resident should be able to locate a consulting physicin and communicate timely a report.

▪ The junior resident should be able to explain the diagnostic or basis of therapeutic procedures performed at the MNI such as spinal nerve blocks, lumbar punctures, cerebral angiography, etc, He/she should be able to explain its possible complications and outcomes.

Collaborator

▪ The junior resident should be able to discuss about an investigation requested, always considering the patient’s best interest.

▪ In order to find the relevant information the junior resident should become familiar with the information resources: the medical chart, OACIS medical system, pharmacy data base, locating members of the treating team, etc.

▪ The resident should be able to suggest any pertinent neurointervention.

▪ The resident should make him/herself available when called by a colleague of a different specialty for discussion of a case.

Leader

▪ The resident should be conscious and responsible in the use of the department’s resources. This will be achieved by participating in the strategical planning of the imaging studies, deciding over their appropiate timing and indications of a given exam. The rotation at the MNI provides the elements to prepare a junior resident to become familiar with how to assessed if an imaging protocol is adequate to the needs of each patient.

▪ The junior resident should become familiar with the local administrative system at the MNI. This will allow him/her to work in a harmonius environment and eventually to contribute with strategies or innovative ideas as to how to improve the services provided.

Health Advocate

▪ The MNI rotation prepares a junior resident to inform the local medical community of new implemented techniques.

▪ The resident should be familiar with different modalities and could recommend the most appropiate imaging studies to investigate cerebrovascular diseases. He/she should be comfortable at recommending a minimally invasive procedure for spinal chronic pain.

▪ The junior resident should be a promoter of radiation protection for patients and health workers.

Medical Expert

▪ The rotation enforces the junior resident’s knowledge about CNS and spine anatomy, clinical and interventional neuroradiology. Aside from the reading expected according to a resident’s level, he/she should:

▪ Attend and participate on the MNI academic meetings (Neuroradiology, Neurology, Neurosurgery).

▪ Participate in the review of all interesting cases and in the discussions with the different clinical teams.

▪ Participate in the coverage of Gadolinium infusions, contributing with venous access, protocol selection, and supervision of the quality of the exam.

▪ Participate in the simulation centre workshop for introduction to neuroendovascular procedures.

▪ Participate in the brain cutting sessions.

▪ To achieve a solid core knowledge a list of topics that the resident should cover is provided as a guidance:

Rotation expectations

On a junior year rotation:

Basic principles in CT and MRI of:

BRAIN

▪ Surface anatomy, the main lobes and general correlation with clinical functions.

▪ Vascular intracranial anatomy. The brain vascular territories.

▪ Stroke: Hemorrhagic and Ischemic.

▪ Primary versus secondary tumours of the brain and meninges.

▪ Infectious lesions: immunocompetent and immunosupressed patients.

▪ Complications after brain, cranial surgery and endovascular procedures.

▪ Demyelinating disease: First diagnosis, recurrent disease and complications of its treatment: PML, IRIS.

▪ Hydrocephalus, NPH and Pseudotumour cerebri. Types of ventricular derivations and their complications.

▪ Cerebrovascular disease: Atherosclerotic disease, vasculitis, amyloid angiopathy.

SPINE

▪ Anatomy

▪ Common degenerative disease. DDD. Indications for surgery and FBSS

▪ Infections: Iatrogenic, acquired, aseptic inflammatory lesions of the spine. Indications for percutaneous procedures and surgical interventions.

▪ Neoplasia: Bone multiple myeloma, metastasis and primary bone lesions. Nerve sheath tumours and meningiomas.

▪ Myelopathy: MS and ADEM.

For a senior year rotation:

The resident should be familiar with the above basic list and will explore in detail less common conditions as follows:

▪ Sella turcica lesions.

▪ Differentiation of primary glial and neuronal tumours. Pseudoprogression and radionecrosis in glial tumours.

▪ Phakomatosis: VHL, Neurofibromatosis.

▪ Dural AVFistulas, Cavernomas and Brain AVMs.

▪ Different approaches for treatment of cerebral aneurysms. Its indication and possible outcomes.

▪ Leukoencephalopaties and developmental anomalies of the brain cortex in patients with epilepsy.

▪ Reversible vasoconstriction syndrome and PRES.

▪ Spinal intramedullary tumours. Syringomyelia and cord myelopathies.

Specific Objectives

Junior Resident

JUNIOR RESIDENT ROTATION AT THE MNH (This also applies for medical students, neurology and neurosurgery residents)

▪ EXPECTED:The goal of the first rotation is to master the anatomy and the general objectives on CT and MRI.

▪ GREAT ACHIEVEMENT: To master the anatomy, general objectives on CT and MRI. Presenting an interesting case at internal neuroradiology rounds.

▪ OUTSTANDING ROTATION: To be able to achieve the expected, surpass it and to do an academic activity such as a presentation, teaching lesson during weekly rounds or Neurostudy club.

Senior resident

This also applies for a second time rotation for residents of any specialties

▪ To achieve what was not possible during the first rotation

▪ To achieve the third specific objective of the junior’s rotation.

Recommended books:

The following books are available at the MNH library.

▪ Neuroradiology: The Requisites Hardcover Jul 7 2016, by Rohini Nadgir MD (Author), David M. Yousem MD MBA (Author)

▪ Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals‬‬, ‪Carlos Zamora‬‪, Mauricio Castillo‬‬, Wolters Kluwer Health, Aug 3, 2016

▪ Diagnostic Imaging: BrainOct 20 2015, by Anne G Osborn MD FACR and Karen L. Salzman MD

▪ Magnetic Resonance Imaging of the Brain and Spine Hardcover use pre formatted date that complies with legal requirement from media matrix – Sep 20 2016, by Scott W. Atlas

Rotation Responsibilities:

Clinical:

▪ Provide supervision/guidance to the technologist in MRI for cases requiring gadolinium from 5:00 - 6:30 pm following a schedule organized by the MNH fellow. Please see separate sheet of CanMEDs objectives for this activity.

▪ Report all cases assigned to resident. All cases to be reviewed by supervising Neuroradiologist (progressive autonomy).

▪ Performance of lumbar puncture under direct supervision.

Teaching:

▪ The resident is required to bring interesting cases to the internal Thursday noon’s rounds.

Supervision/teaching of elective medical students or off-service residents.

▪ Prepare 5 interesting cases in power point for teaching files and e mail them at the end of the rotation

▪ Include all interventional procedures in personal log book.

Rounds

▪ Attend the Neurosurgery pertinent presentations on Fridays.

▪ Attend the Monthly cerebrovascular Thursday’s rounds.

▪ Attend the concordance Neuroradiology rounds.

▪ Attend the tumour board, stroke rounds and white matter rounds.

▪ Attend bi-monthly Neuroradiology Study Club

Evaluation:

▪ Assessed by Neuroradiology staff radiologists.

▪ A mid rotation verbal evaluation will be given by any of the staff.

▪ The final evaluation will be filled out in presence of the resident by the staff (at least two staff will try to always be present) in private meeting.

▪ Assessment of quality of Teaching Files created during rotation, punctuality, attendance and participation in the department’s activities are assets.

Expected Volumes

First time rotation: (FOUR WEEK ROTATION)

Progressive increase of number of studies is recommended.

▪ Start first only with CT head, continue with CT Spine, CTA COW and Carotids.

▪ Second Week Start with MRI Brain, continue with MRI SPINE.

For Second Time Rotation:

▪ MRI brain/spine - 6 cases

▪ CT head/spine - 20 cases

▪ Plain films - 5 cases

▪ Doppler carotids - 2 case

Lumbar punctures Residents are encouraged to attend and perform all the lumbar punctures (LP) on the daily program.

|Hospital Site |Rotation |Caseload |Expected Case |Expected Case Volume |Goals & Objectives |Goals & Objectives |

| | | |Volume for Junior |for Senior |Document for Junior |Document for Senior |

|MNI |Neuro |CT/week= 126 |8 |15 |[pic] |[pic] |

| | |[pic] | | | | |

| | |CTA/12-15 week |1 |2 | | |

| | |CT Spine 15 |2 |3 | | |

| | |MRI 90/week |5 |5 | | |

| | |X rays |3 |5 | | |

| | |45/weeks | | | | |

| | |Carotid US |1 |2 | | |

| | |16 | | | | |

Neuroradiology for Senior Residents

Goals:

The rotation at the MNI provides the senior resident with the opportunity to learn from a varied group of CNS pathologies. At the MNI the exposure to both diagnostic and neuroendovascular cases will help the resident to feel at ease with neuroradiology cases in a general radiology practice. The resident will be able to advise the clinician and patient on the potential uses of Neurointerventional procedures. The trainee will feel comfortable consulting with Neurologists, Neurosurgeons and other clinicians. In addition, the resident will acquire expertise in order to carry out diagnostic procedures such as myelograms and diagnostic lumbar punctures.

Objectives

Professional

▪ The rotation at the MNH intends to help the resident consolidate a practice based on respect and honorableness toward patients, colleagues, and staff of the Neuroradiology service.

▪ Senior residents are expected:

▪ To keep confidentiality of patient’s files.

▪ To embrace cultural differences and to being able to discuss relevant clinical information with peers, staff and health allied personal.

▪ To accept feedback of their performance.

▪ To arrive on time to activities and to leave once the activities are finished. To ensure that any request for medical attention to patients required during his/her presence in the radiology department is promptly answered.

Communicator

▪ The rotation at the MNI will provide the SENIOR resident with the elements to generate a clear neuroradiological report taking into consideration the previous imaging and present clinical condition of patient. This report should address the query of the referring physician, and will recommend an imaging modality of choice to guide further investigation.

▪ During the rotation the SENIOR resident should be able to locate a consulting physician and communicate timely a report.

▪ The senior resident should be able to explain the diagnostic or basis of therapeutic procedures performed at the MNI such as spinal nerve blocks, lumbar punctures, cerebral angiography, etc, He/she should be able to explain its possible complications and outcomes.

Collaborator

▪ The senior resident should be able to discuss about an investigation requested, always considering the patient’s best interest.

▪ In order to find the relevant information, the senior resident should become familiar with the information resources: the medical chart, OACIS medical system, pharmacy data base, DSQ, locating members of the treating team, etc.

▪ The resident should be able to suggest any pertinent neurointervention.

▪ The resident should make him/herself available when called by a colleague of a different specialty for discussion of a case.

Leader

▪ The resident should be conscious and responsible in the use of the department’s resources. This will be achieved by participating in the strategical planning of the imaging studies, deciding over their appropiate timing and indications of a given exam. The rotation at the MNI provides the elements to prepare a senior resident to become familiar with how to assess if an imaging protocol is adequate to the needs of each patient.

▪ The senior resident should become familiar with the local administrative system at the MNI. This will allow him/her to work in a harmonius environment and eventually to contribute with strategies or innovative ideas as to how to improve the services provided.

Heath Advocate

▪ The MNI rotation prepares a SENIOR resident to inform the local medical community of new implemented techniques.

▪ The resident should be familiar with different modalities and could recommend the most appropiate imaging studies to investigate cerebrovascular diseases. He/she should be comfortable at recommending a minimally invasive procedure for spinal chronic pain.

▪ The senior resident should be a promoter of radiation protection for patients and health workers.

Medical Expert

▪ The rotation enforces the SENIOR resident’s knowledge about CNS and spine anatomy, clinical and interventional neuroradiology. Aside from the reading expected according to a resident’s level, he/she should:

▪ Attend and participate on the MNI academic meetings (Neuroradiology, Neurology, Neurosurgery).

▪ Participate in the review of all interesting cases and in the discussions with the different clinical teams.

▪ Participate in the coverage of Gadolinium infusions, contributing with venous access, protocol selection, and supervision of the quality of the exam.

▪ Participate in the brain anatomy cutting sessions, concordance neuroradiology rounds, internal diagnostic neuroradiology rounds, workshop for fluoroscopy guided spine procedures.

▪ To achieve a solid core knowledge a list of topics that the resident should cover is provided as a guidance:

▪ On a SENIOR year rotation the following topics should be already known by the resident.

Basic principles in CT and MRI of:

Brain

▪ Surface anatomy, the main lobes and general correlation with clinical functions.

▪ Vascular intracranial anatomy. The brain vascular territories.

▪ Stroke: Hemorrhagic and Ischemic.

Primary versus secondary tumours of the brain and meninges.

▪ Infectious lesions: immunocompetent and immunosupressed patients.

▪ Complications after brain, cranial surgery and endovascular procedures.

▪ Demyelinating disease: First diagnosis, recurrent disease and complications of its treatment: PML, IRIS.

▪ Hydrocephalus, NPH and Pseudotumour cerebri. Types of ventricular derivations and their complications.

▪ Cerebrovascular disease: Atherosclerotic disease, vasculitis, amyloid angiopathy.

Spine

▪ Anatomy

▪ Common degenerative disease. DDD. Indications for surgery and FBSS

▪ Infections: Iatrogenic, acquired, aseptic inflammatory lesions of the spine. Indications for percutaneous procedures and surgical interventions.

▪ Neoplasia: Bone multiple myeloma, metastasis and primary bone lesions. Nerve sheath tumours and meningiomas.

▪ Myelopathy: MS and ADEM.

For a senior year rotation:

The resident should be familiar with the above basic list and will explore in detail less common conditions as follows:

▪ Sella turcica lesions.

▪ Differentiation of primary glial and neuronal tumours. Pseudoprogression and radionecrosis in glial tumours.

▪ Phakomatosis: VHL, Neurofibromatosis.

▪ Dural AVFistulas, Cavernomas and Brain AVMs.

▪ Different approaches for treatment of cerebral aneurysms. Its indication and possible outcomes.

▪ Leukoencephalopaties and developmental anomalies of the brain cortex in patients with epilepsy.

▪ Reversible vasoconstriction syndrome and PRES.

▪ Spinal intramedullary tumours. Syringomyelia and cord myelopathies.

Specific Objectives

▪ To achieve what was not possible during the first rotation

▪ To achieve the third specific objective of the junior’s rotation.

Recommended books:

The following books are available at the MNH library.

▪ Neuroradiology: The Requisites Hardcover Jul 7 2016, by Rohini Nadgir MD (Author), David M. Yousem MD MBA (Author)

▪ Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals‬‬, ‪Carlos Zamora‬‪, Mauricio Castillo‬‬, Wolters Kluwer Health, Aug 3, 2016

▪ Diagnostic Imaging: BrainOct 20 2015, by Anne G Osborn MD FACR and Karen L. Salzman MD

▪ Magnetic Resonance Imaging of the Brain and Spine Hardcover use pre formatted date that complies with legal requirement from media matrix – Sep 20 2016, by Scott W. Atlas

Rotation Responsibilities:

Clinical:

▪ Provide supervision/guidance to the technologist in MRI for cases requiring gadolinium from 5:00 - 6:45 pm following a schedule organized by the MNH fellow. Please see separate sheet of CanMEDs objectives for this activity.

▪ Report all cases assigned to resident. All cases to be reviewed by supervising Neuroradiologist (progressive autonomy).

▪ Performance of lumbar puncture under direct supervision.

Teaching:

▪ The resident is required to bring interesting cases to the internal Thursday noon’s rounds.

▪ Supervision/teaching of elective medical students or off-service residents.

▪ Prepare 5 interesting cases in power point for teaching files and e mail them at the end of the rotation

▪ Include all interventional procedures in personal log book.

Rounds

▪ Attend the Neurosurgery pertinent presentations on Fridays.

▪ Attend the Monthly cerebrovascular Thursday’s rounds.

▪ Attend the concordance Neuroradiology rounds.

▪ Attend the tumour board, stroke rounds and white matter rounds.

▪ Attend bi-monthly Neuroradiology Study Club

Evaluation:

▪ Assessed by Neuroradiology staff radiologists.

▪ A mid rotation verbal evaluation will be given by any of the staff.

▪ The final evaluation will be filled out in presence of the resident by the staff (at least two staff will try to always be present) in private meeting.

▪ Assessment of quality of Teaching Files created during rotation, punctuality, attendance and participation in the department’s activities are assets.

First time rotation: (FOUR WEEK ROTATION)

Progressive increase of number of studies is recommended.

▪ Start first only with CT head, continue with CT Spine, CTA COW and Carotids.

▪ Second Week Start with MRI Brain, continue with MRI SPINE.

For Second Time Rotation:

▪ MRI brain/spine - 6 cases

▪ CT head/spine - 20 cases

▪ Plain films - 5 cases

▪ Doppler carotids - 2 case

Lumbar punctures Residents are encouraged to attend and perform all the lumbar punctures (LP) on the daily program.

|Hospital Site |Rotation |Caseload |Expected Case |Expected Case Volume |Goals & Objectives |Goals & Objectives |

| | | |Volume for Junior |for Senior |Document for Junior |Document for Senior |

|MNI |Neuro |CT/week= 126 |8 |15 |[pic] |[pic] |

| | |[pic] | | | | |

| | |CTA/12-15 week |1 |2 | | |

| | |CT Spine 15 |2 |3 | | |

| | |MRI 90/week |5 |5 | | |

| | |X rays |3 |5 | | |

| | |45/weeks | | | | |

| | |Carotid US |1 |2 | | |

| | |16 | | | | |

-----------------------

McGill

Department of Diagnostic Radiology

Département de Radiologie Diagnostique

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