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Clinical Rotations

Abdominal Imaging (GI/GU Fluoroscopy)

Competency-Based Goals and Objectives

by level of training

(Pediatric fluoroscopic imaging G&O are included in the pediatric rotations.)

Rotation One

1. Medical Knowledge

Instrumentation and Protocols

• Basic fluoroscopic instrumentation

• Common fluoroscopic artifacts

• Become familiar with protocols

• Types of oral and intravenous contrast

Bowel

• Normal appearance of the esophagus, stomach, small bowel and colon on fluoroscopic examination

• Common inflammatory conditions of the gastrointestinal tract

• Neoplasms of the gastrointestinal tract

• Perforation/leak: esophagus, post-operative stomach and small bowel

• Normal variants

• Infectious colitis, ischemic bowel and bowel perforation

• Bowel obstructions and underlying etiology

• Intussusception, volvulus, closed loop obstruction, incarcerated hernias, strangulation

Gynecology

• Normal appearance of the uterus and uterine tubes on hysterosalpingography

• Abnormal appearance of the uterus and uterine tubes on hysterosalpingography including complications from pelvic inflammatory disease

Urethra and Bladder

• Normal and abnormal appearance of the urethra on retrograde urethrogram (RUG)

• Normal and abnormal appearance of the urinary bladder and urethra on voiding cystourethrogram (VCUG)

Assessment methods

• Faculty evaluations

• Mock orals

• ACR in-service examination results

2. Patient Care

• Gather essential and accurate clinical information about patients relevant to the interpretation of the examination including correlation with prior radiological studies.

• Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the image-guided procedure as well as its clinical significance.

• Use information technology to support patient care decisions.

• Perform fluoroscopic examinations such as esophagrams, upper GI series, small bowel follow through series, contrast enemas, video swallow examination, dobhoff tube placement, urethrogram, VCUG

Assessment Methods

• Faculty evaluations

• 360 evaluations

• Mock orals

• Semi-annual review of procedure log

3. Practice-Based Learning and Improvement

• Participate in self-directed learning including outside reading on anatomy and common pathology supplemented with information on emergency/trauma processes.

• Participate in QA/QI activities.

• Use information technology to access on-line medical information, and to facilitate self-directed learning.

Assessment Methods

• Faculty evaluations

• Learning portfolios (learning plan)

• Mock orals

• ACR in-service examination

4. Interpersonal and Communication Skills

• Dictate prompt, accurate and concise radiological reports for basic studies.

• Develop effective communication skills with patients, patients’ families, physicians and other members of the health care team.

• Obtain informed consent for procedures with faculty guidance.

• Promptly communicate urgent, critical or unexpected findings to residents, referring physicians or clinicians and document the communication in the radiological report.

Assessment Methods

• Faculty evaluations

• 360 evaluations

• Formal evaluation of resident dictations documented in resident learning portfolios

5. Professionalism

• Demonstrate integrity, respect and compassion to patients, physicians, staff and other health care professionals.

• Demonstrate positive work habits, including punctuality and professional appearance.

• Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information.

• Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation.

Assessment Methods

• Faculty evaluations

• 360 evaluations

• Semi-annual review of conference attendance

6. Systems-Based Practice

• Understand how medical decisions affect patient care within the larger system.

• Demonstrate knowledge of and apply appropriateness criteria and other cost-effective healthcare principles to professional practice.

Assessment Method

• Faculty evaluations

Suggested References

• Manual on Fluoroscopic Techniques at workstation

• The Requisites in GI, GU

Rotation Two

1. Medical Knowledge

Bowel

• More complex bowel surgery post-operative appearance

• Uncommon neoplasms of the GI tract

• Barrett’s esophagus

• Rings, webs and strictures

• Polyposis syndromes

• Henoch-Schonlein purpura

• Polyarteritis nodosa

• Systemic lupus erythematosis

• NSAIDS enteritis

• Varices

• Malabsorption

• Sprue

• Lymphangiectasia

• Carcinoid

• Inflammatory conditions of the GI tract

Assessment Methods

• Faculty evaluations

• Mock orals

• ACR in-service

2. Patient Care

• Screen, supervise and perform more complex studies

• Correlate fluoroscopic examinations with cross-sectional imaging such as CT and MRI

Assessment Methods

• Faculty evaluations

• 360 evaluations

• Semi-annual review of procedure log

3. Practice-Based Learning and Improvement

• Participate in self-directed learning with outside reading from the Mayo Clinic Review and the Case Review Series.

• Demonstrate knowledge and the application of the principles of evidence-based medicine in practice.

• Participate in QA/QI activities.

Assessment Methods

• Faculty evaluations

• Learning portfolios (learning plan)

• Mock orals

• ACR in-service examination

4. Interpersonal and Communication Skills

• Interact with residents and attending physicians in consultation to enhance clinical radiological correlation.

• Dictate accurate and concise radiological reports for more complex studies with concise impression including diagnosis and/or differential diagnoses

Assessment Methods

• Faculty evaluations

• Direct observation by the faculty

• Formal evaluation of resident dictations documented in resident learning portfolios

5. Professionalism

• Demonstrate responsiveness to the needs of patients that supercedes self-interest (altruism).

• Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation.

Assessment Methods

• Faculty evaluations

• 360 evaluations

• semi-annual review of conference attendance

6. Systems-Based Practice

• Effectively prioritize patients requiring cross-sectional imaging studies.

• Participate in discussions with faculty regarding system challenges and potential solutions regarding radiological service and patient care.

Assessment Method

• Faculty evaluations

Suggested References:

• Mayo Clinic Gastrointestinal Imaging Review by C. Daniel Johnson and Grant D. Schmit

• Case Review Series for GI, GU

• On-line teaching files

A complete list of GI/GU learning objectives is included in the Abdominal Imaging G&O.

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