STANFORD UNIVERSITY MEDICAL CENTER
|Rotation: Ultrasound |Rotation Duration: 4 wks |Month(s): 3-4 |
|Institution: Stanford, VA |Call Responsibility: none |Night(s): covered by Night float |
|Responsible Faculty Member(s): |Location: |
|R. Brooke Jeffrey Jr., M.D. |Stanford hospital (2 months) |
|F. Graham Sommer, M.D. |VA DRC (1 month) |
|Terry Desser, M.D. |Johnson Perinatal Diagnostic Center, 3rd floor SUH |
|Bruce Daniel, M.D. |UCSF- optional fourth-year elective |
|Aya Kamaya, M.D. | |
|Juergen Willmann, MD PhD | |
|Lewis Shin, MD | |
|Ray Hsu, MD | |
|Richard Barth, M.D. (OB ultrasound) | |
| |Phone Numbers: |
| |Stanford Hospital: |
| |Ultrasound reading room: 498-2401, 723-3499 |
| |Ultrasound lab: 723-3498 |
| |OB ultrasound: 725-7030 |
| |VA Hospital: |
| |650-493-5000 ( +extension) |
| |front desk: 64489 |
| |Technologist: 63824, 63020 |
| |Reading room: 65250, 63886 |
|Technologists/Technical Staff: |Training Level: |
|Diane Orluck, RDMS, Chief Technologist |Stanford-years 1, 3 |
|Amber Gee, |VA-year 2 |
|Alex Karanany | |
|Amanada Nelson | |
|Carol Walters | |
|Christy Hill | |
|Ke Chen | |
|Lan Zhang | |
|Lillie Utley | |
|Marianne Johnson | |
|Rebecca Wong | |
|Pam Daniel, Sarah Brandon, Shirley Furuichi, Xin Yuan | |
|Goals & Objectives- |
|A note about goals and objectives- The goals and objectives outlined in this document are based upon the six core competencies as defined by the |
|ACGME. As residents gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise |
|those skills with greater independence. This concept—graded and progressive responsibility—is one of the core tenets of American graduate medical |
|education. This document should provide you a framework for the stepwise progression of your knowledge and skills. |
| |
| |
| |
|ROTATION 1: FIRST YEAR-Stanford Hospital Ultrasound |
| |
|This rotation involves interpretation of basic sonography of the abdomen, pelvis, thyroid, scrotum, and obstetrical cases. Also, introduction to |
|color and spectral Doppler studies of carotid arteries, upper and lower extremity and abdominal vasculature. Some ultrasound-guided aspirations and|
|biopsies will be performed on the ultrasound rotation and others on the interventional rotation. |
| |
|Patient Care |
| |
|Goal: |
| |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the |
|promotion of health. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Be familiar with all departmental US protocols found in reading room binder. |
|Know the key types of ultrasound examinations. |
|Understand indications, contraindications, and patient preparation for sonographically-guided procedures. |
|Demonstrate basic knowledge of EPIC, Nuance Radwhere voice recognition software, centricity RIS, GE centricity PACS, and the Siemens KinetDX |
|ultrasound workstation. |
|Become familiar with ultrasound machinery and transducers. |
|Become familiar with the use of Color Doppler and harmonics. |
|Learn the basics of ultrasound analysis. |
| |
|Skill Objectives: |
| |
|Become facile with scanning, using PACS and utilizing available information technology to manage patient information. |
|Observe and assist in US-guided aspirations and biopsies under direction of faculty or fellow. |
|Perform basic sonography with minimal assistance, including US of the chest, abdomen, pelvis, and lower extremities. |
|Procedure Log: Log at least 20 DVT cases, some of which should be upper extremity cases. |
|Coordinate activities in the reading room, including assisting the staff MD on providing direction for the technologists, consultation for other |
|clinicians, and answering the phone. |
|Gather clinical and radiological data on patients referred for ultrasound exam. |
|Develop diagnostic plan based on the clinical presentation and prior imaging. |
|Understand the clinical questions to be addressed by the study by calling the referring physician if necessary. |
|Review ultrasound requisitions to be sure that the correct type of study has been ordered to answer the clinical question. |
|Perform exams responsibly and safely, assuring that the correct exam is ordered and performed. |
|Review images with the ultrasound technologists as studies are completed to insure that sufficient, diagnostic images have been obtained. Request |
|additional images as needed. |
|Develop hands-on scanning skills and learn the operation of the ultrasound instrument. |
|Demonstrate the ability to use the internet as an educational instrument: PubMed, RSNA site, Google, Stat DX. |
|Generate differential diagnoses based in imaging findings and clinical data. |
| |
| |
|Behavior and Attitude Objectives: |
| |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. |
|Active participation with faculty in patient workup. |
|Graduated responsibility in performing radiologic procedures. |
| |
|Medical Knowledge |
| |
|Goal: |
| |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as |
|the application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand clinical application of ultrasound. |
|Identify relevant anatomic structures on US images. |
|Diagnose common pathologic conditions in the abdomen and pelvis and understand their pathophysiology. |
|Understand the elements of key ultrasound examinations including gallbladder, liver, renal, pelvic, FAST for ER, chest for fluid, extremity for |
|DVT. The goal at this level is to begin to understand the basics and what it takes to master them. |
|Learn the pathophysiology and diagnostic criteria of the diagnoses listed in appendix A. in preparation for a call |
| |
|Skill Objectives: |
| |
|Perform basic sonography with minimal assistance, including US of the chest for fluid, abdomen for gallbladder or liver disease, pelvis for |
|fibroids or ectopic, and lower extremities for thrombosis. |
|Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. |
|Demonstrate a clinically appropriate diagnostic treatment plan. |
|Demonstrate the proper use of radiological equipment. |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
|Practice-Based Learning and Improvement |
| |
|Goal: |
| |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to |
|continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to |
|be able to: |
| |
|Knowledge Objectives: |
| |
|Assess US images for quality and suggest methods of improvement. |
| |
|Skill Objectives: |
| |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
|Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. |
|Keep a log of clinical and interpretive questions that arise during readout of cases, and research answers to at least 2 questions per week. |
|Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. |
|Demonstrate critical assessment of the scientific literature. |
|Use internet and online and print resources to answer clinical questions. |
| |
|Behavior and Attitude Objectives: |
| |
|Incorporate formative feedback into daily practice. |
|Follow-up interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
|Participation in body imaging journal club. |
|Preparation of cases for multi-disciplinary conferences. |
|Participation in ultrasound conference. |
|Demonstrate the ability to use all relevant information resources to acquire evidence-based data. |
|Demonstrate understanding of the principles of research project design and implementation. |
| |
|Systems Based Practice |
| |
|Goal: |
| |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call |
|effectively on other resources in the system to provide optimal health care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand how their image interpretation affects patient care. |
|Demonstrate knowledge of funding sources for research and clinical care. |
|Demonstrate knowledge of reimbursement methods. |
|Demonstrate knowledge and sensitivity to workflow and resource utilization issues. |
|Demonstrate knowledge of the regulatory environment. |
|Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision |
|and management of staff. |
|Learn about the AIUM accreditation standards for Ultrasound laboratories. |
| |
|Skill Objectives: |
| |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. |
|Practice cost-effective use of time and support personnel. |
|Demonstrate ability to design cost-effective care plans. |
|Review of literature, including ACR Appropriateness Criteria. |
| |
|Behavior and Attitude Objectives: |
| |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
|Attendance and participation in multi-disciplinary conference. |
|Interaction with department administrators. |
|Membership and participation in local and national radiological societies. |
| |
|Professionalism |
| |
|Goal: |
| |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are |
|expected to demonstrate: |
| |
|Knowledge Objectives: |
| |
|Understanding of the need for respect for patient privacy and autonomy. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning|
|to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. |
|If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate |
|faculty and/or fellow. |
|Demonstrate knowledge of issues of impairment. |
| |
|Skill Objectives: |
| |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, |
|disabilities, and sexual orientation. |
|Professionalism and compassion while obtaining informed consent in all patients undergoing US-guided procedure. |
| |
|Behavior and Attitude Objectives: |
| |
|Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
|Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one's career. |
|Demonstrate honesty with patients and staff. |
|Demonstrate honor and integrity: avoid conflict of interests when accepting gifts from patients and vendors. |
|Demonstrate positive work habits, including punctuality and professional appearance. |
| |
|Interpersonal and Communication Skills |
| |
|Goal: |
| |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, |
|their families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
| |
|Produce concise and accurate reports on most examinations, provide a clear report based on standard radiologic terminology. |
|Communicate effectively with physicians, other health professionals. |
|Obtain informed consent with the utmost professionalism. |
|Obtain pertinent clinical information and clear understanding of diagnostic question to be answered by communicating directly with clinicians if |
|necessary. |
|Communicate relevant clinical history to ultrasound technologists. |
|Provide direct communication to referring physicians, and documenting communication in report for all significant positive findings. |
|Demonstrate skills in obtaining informed consent, including effective communication to patients of the procedure, alternatives, and possible |
|complications. |
|Demonstrate the verbal and non-verbal skills necessary for face to face listening and speaking to physicians, families, and support personnel. |
|Demonstrate findings to clinicians when they come to ultrasound department to review study. |
| |
|Behavior and Attitude Objectives: |
| |
|Work effectively as a member of the patient care team. |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|ROTATION 2: Second Year- VA |
| |
|This rotation involves interpretation of intermediate sonography of the abdomen, pelvis, thyroid, scrotum, and obstetrical cases. Also, |
|introduction to color and spectral Doppler studies of carotid arteries, upper and lower extremity and abdominal vasculature. Some ultrasound-guided|
|aspirations and biopsies will be performed on the ultrasound rotation and others on the interventional rotation. |
| |
|Patient Care |
| |
|Goal: |
| |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the |
|promotion of health. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Be increasingly familiar with all departmental US protocols. |
|Know the majority of types of ultrasound examinations, see below. |
|Understand indications, contraindications, and patient preparation for sonographically-guided procedures. |
|Increased familiarity with machines and transducers: optimizing Doppler settings. |
| |
|Skill Objectives: |
| |
|Demonstrate advanced knowledge of EPIC. |
|Become increasingly facile with Scanning, using PACS and utilizing available information technology to manage patient information. |
|Perform intermediate sonography with minimal assistance, including US of the chest, abdomen, pelvis, and lower extremities. |
|Procedure Log: Log at least 10 abdomen and 10 pelvis cases. |
|Coordinate activities in the reading room, including assisting the staff MD on providing direction for the technologists, consultation for other |
|clinicians, and answering the phone. |
|Gather clinical and radiological data on patients referred for ultrasound exam. |
|Develop diagnostic plan based on the clinical presentation and prior imaging. |
|Understand the clinical questions to be addressed by the study by calling the referring physician if necessary. |
|Review ultrasound requisitions to be sure that the correct type of study has been ordered to answer the clinical question. |
|Perform exams responsibly and safely, assuring that the correct exam is ordered and performed. |
|Review images with the ultrasound technologists as studies are completed to insure that sufficient, diagnostic images have been obtained. Request |
|additional images as needed. |
|Develop hands-on scanning skills and learn the operation of the ultrasound instrument |
|Demonstrate the ability to use the internet as an educational instrument: PubMed, RSNA site, Google, Stat DX. |
|Generate differential diagnoses based in imaging findings and clinical data. |
|Endovaginal and transabdominal scans of the pelvis: Second and third year residents should learn the techniques for performing these examinations, |
|and should learn how to set up the endovaginal probe. They should also learn the proper technique for disinfecting the probe between studies. |
|Abdominal ultrasound: Second and third year residents should learn to perform emergency scans of the abdomen for indications such as suspected |
|cholecystitis. |
|Learn to perform imaging of the acute scrotum for suspected torsion and epididymitis. |
| |
| |
|Behavior and Attitude Objectives: |
| |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. |
|Active participation with faculty in patient work-up. |
|Graduated responsibility in performing radiologic procedures. |
| |
|Medical Knowledge |
| |
|Goal: |
| |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as |
|the application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand clinical application of ultrasound. |
|Identify relevant anatomic structures on US images. |
|Diagnose common and uncommon pathologic conditions in the abdomen and pelvis and understand their pathophysiology. |
|Understand the elements of key ultrasound examinations including gallbladder, liver, renal, pelvic, FAST for ER, chest for fluid, extremity for |
|DVT. |
|Learn to analyze and diagnose IUP, ectopic pregnancy, adnexal mass, pancreatic mass, liver mass, spleen mass, kidney mass, bladder mass, and |
|ovarian mass. |
|Learn appropriate differential diagnoses and methods for further analysis. |
|Learn to analyze and diagnose ultrasound studies of the neck and scrotum, carotid duplex studies. |
|Review and understand at least half of the diagnoses listed in appendix B. |
| |
|Skill Objectives: |
| |
|Perform intermediate sonography with minimal assistance, including US of the chest for fluid, abdomen for gallbladder or liver disease, pelvis for |
|fibroids or ectopic, and lower extremities for thrombosis. |
|Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. |
|Demonstrate progress during subsequent rotations. |
|Demonstrate a clinically appropriate diagnostic treatment plan. |
|Demonstrate the proper use of radiological equipment. |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
|Practice-Based Learning and Improvement |
| |
|Goal: |
| |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to |
|continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to |
|be able to: |
| |
|Knowledge Objectives: |
| |
|Assess US images for quality and suggest methods of improvement. |
| |
|Skill Objectives: |
| |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
|Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. |
|Keep a log of clinical and interpretive questions that arise during readout of cases, and research answers to at least 2 questions per week. |
|Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. |
|Demonstrate critical assessment of the scientific literature. |
|Use internet and online and print resources to answer clinical questions. |
|Demonstrate understanding of the principles of research project design and implementation. |
|Demonstrate the ability to use all relevant information resources to acquire evidence-based data. |
| |
|Behavior and Attitude Objectives: |
| |
|Incorporate formative feedback into daily practice. |
|Follow-up interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
|Participate in journal club, clinical conferences, and independent reading. |
|Participation in body imaging journal club. |
|Preparation of cases for multi-disciplinary conferences. |
| |
|Systems Based Practice |
| |
|Goal: |
| |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call |
|effectively on other resources in the system to provide optimal health care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand how their image interpretation affects patient care. |
|Demonstrate knowledge of funding sources for research and clinical care. |
|Demonstrate knowledge of reimbursement methods. |
|Demonstrate knowledge and sensitivity to workflow and resource utilization issues. |
|Demonstrate knowledge of the regulatory environment. |
|Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision |
|and management of staff. |
|Learn about the AIUM accreditation standards for ultrasound laboratories. |
| |
|Skill Objectives: |
| |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. |
|Practice using cost effective use of time and support personnel. |
|Demonstrate ability to design cost-effective care plans. |
|Review of literature, including ACR Appropriateness Criteria. |
| |
|Behavior and Attitude Objectives: |
| |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
|Attendance and participation in multi-disciplinary conference. |
|Interaction with department administrators. |
|Membership and participation in local and national radiological societies. |
| |
|Professionalism |
| |
|Goal: |
| |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are |
|expected to demonstrate: |
| |
|Knowledge Objectives: |
| |
|Understanding of the need for respect for patient privacy and autonomy. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning|
|to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. |
|If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate |
|faculty and/or fellow. |
|Demonstrate knowledge of issues of impairment. |
| |
|Skill Objectives: |
| |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, |
|disabilities, and sexual orientation. |
|Professionalism and compassion while obtaining informed consent in all patients undergoing US-guided procedure. |
| |
|Behavior and Attitude Objectives: |
| |
|Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
|Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one's career. |
|Demonstrate honesty with patients and staff. |
|Demonstrate honor and integrity: avoid conflict of interests when accepting gifts from patients and vendors. |
|Demonstrate positive work habits, including punctuality and professional appearance. |
| |
|Interpersonal and Communication Skills |
| |
|Goal: |
| |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, |
|their families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
| |
|Produce concise and accurate reports on most examinations, provide a clear report based on standard radiologic terminology. |
|Communicate effectively with physicians, other health professionals. |
|Obtain informed consent with the utmost professionalism. |
|Obtain pertinent clinical information and clear understanding of diagnostic question to be answered by communicating directly with clinicians if |
|necessary. |
|Communicate relevant clinical history to ultrasound technologists. |
|Provide direct communication to referring physicians, and documenting communication in report for all significant positive findings. |
|Demonstrate skills in obtaining informed consent, including effective communication to patients of the procedure, alternatives, and possible |
|complications. |
|Demonstrate the verbal and non-verbal skills necessary for face to face listening and speaking to physicians, families, and support personnel. |
|Demonstrate findings to clinicians when they come to ultrasound department to review study. |
| |
|Behavior and Attitude Objectives: |
| |
|Work effectively as a member of the patient care team. |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|ROTATION 3-Stanford Hospital |
| |
|This rotation involves performance and interpretation of advanced sonography of the abdomen, pelvis, thyroid, scrotum, and obstetrical cases. Also,|
|an advanced level of color and spectral Doppler studies of carotid arteries, upper and lower extremity and abdominal vasculature. Some |
|ultrasound-guided aspirations and biopsies will be performed on the ultrasound rotation and others on the interventional rotation. |
| |
|Patient Care |
| |
|Goal: |
| |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the |
|promotion of health. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Describe more common and uncommon sonographic artifacts. |
|List indications, contraindications, and patient preparation for sonographically-guided procedures. |
|Continued mastery of material from rotation 2. |
|Normal OB exam and possible abnormalities. |
| |
|Skill Objectives: |
| |
|Become increasingly facile with scanning and utilize available information technology to manage patient information. |
|Perform US-guided aspirations and biopsies with occasional help from faculty or fellow. |
|Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering |
|the phone. |
|Observe ultrasound-guided biopsy of the thyroid gland. |
|Perform ultrasound localization for ultrasound-guided biopsy of the kidney by the nephrology service. |
| |
|Behavior and Attitude Objectives: |
| |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. |
| |
| |
| |
| |
| |
|Medical Knowledge |
| |
|Goal: |
| |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as |
|the application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand clinical application of ultrasound. |
|Identify relevant anatomic structures on US images. |
|Diagnose all pathologic conditions in the abdomen and pelvis and understand their pathophysiology. |
|Understand principles of Doppler studies of abdominal vasculature, especially transplant studies |
| |
|Skill Objectives: |
| |
|Accurately interpret all US examinations, with only the necessary amount of faculty assistance. |
|Begin to perform more complex sonographic examinations such as US of the carotid and visceral arteries, upper extremity arteries and veins, |
|scrotum, and gravid uterus. |
|Demonstrate understanding of the pathophysiology and diagnostic criteria for all of the diagnoses listed in appendix B. |
|Endovaginal and transabdominal scans of the pelvis: Second and third year residents should learn the techniques for performing these examinations, |
|and should learn how to set up the endovaginal probe. They should also learn the proper technique for disinfecting the probe between studies. |
|Abdominal ultrasound: Second and third year residents should learn to perform emergency scans of the abdomen for indications such as suspected |
|cholecystitis. |
|Learn to perform imaging of the acute scrotum for suspected torsion and epididymitis. |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
| |
|Practice-Based Learning and Improvement |
| |
|Goal: |
| |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to |
|continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to |
|be able to: |
| |
|Knowledge Objectives: |
| |
|Assess US images for quality and suggest methods of improvement. |
| |
|Skill Objectives: |
| |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
| |
|Behavior and Attitude Objectives: |
| |
|Incorporate formative feedback into daily practice. |
|Follow-up interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
| |
|Systems Based Practice |
| |
|Goal: |
| |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call |
|effectively on other resources in the system to provide optimal health care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand how their image interpretation affects patient care. |
| |
|Skill Objectives: |
| |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay, |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted; and |
|Practice using cost effective use of time and support personnel. |
| |
|Behavior and Attitude Objectives: |
| |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
| |
| |
|Professionalism |
| |
|Goal: |
| |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are |
|expected to demonstrate: |
| |
|Knowledge Objectives: |
| |
|Understanding of the need for respect for patient privacy and autonomy. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning|
|to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. |
|If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate |
|faculty and/or fellow. |
| |
|Skill Objectives: |
| |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, |
|disabilities, and sexual orientation. |
|Professionalism and compassion while obtaining informed consent in all patients undergoing US-guided procedure. |
| |
|Behavior and Attitude Objectives: |
| |
|Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
| |
| |
|Interpersonal and Communication Skills |
| |
|Goal: |
| |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, |
|their families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
| |
|Produce concise and accurate reports on most examinations. |
|Communicate effectively with physicians, other health professionals. |
|Obtain informed consent with the utmost professionalism. |
| |
|Behavior and Attitude Objectives: |
| |
|Work effectively as a member of the patient care team. |
|ROTATION 4: OB ULTRASOUND ELECTIVE (optional) |
|Can be taken at UCSF—note: this is the ONLY away rotation authorized by our GME office |
|Workflow: |
|The workday begins at approximately 8:30, immediately following morning conference |
|Readouts occur throughout the morning and afternoon. |
|Whenever possible, the resident should preview ultrasound cases with the body imaging fellow before readout. |
|The resident should dictate cases that he/she performed or checked once they have been reviewed with the attending. |
|The resident should field requests for emergency add-on studies and should elicit enough clinical history to insure that the correct study is |
|performed for the condition suspected. He/she should also find out whom to contact with the results, and where any outpatient should be sent when |
|the study is completed. |
|After cases are dictated, a brief summary of the findings should be recorded in the Diagnosis section of the Worksheet for that study on the |
|Ultrasound KinetDx workstation (Ultrasound mini-PACS). |
|First-year residents should also spend time observing the technologists perform diagnostic scans. During the first rotation, they should begin to |
|perform studies of the legs for suspected deep venous thrombosis. |
|Ultrasound conference is held with the attending staff and technologists on Thursdays at 12:30. |
|In OB ultrasound, residents should observe the studies being performed, and sit in on readout sessions. |
|Duties: |
| |
|Required scanning skills: |
| |
|Venous Doppler studies of the extremities: First year residents should learn to perform studies for suspected deep venous thrombosis of the upper |
|and lower extremities. At least 20 cases should be performed. |
| |
|Endovaginal and transabdominal scans of the pelvis: Second and third year residents should learn the techniques for performing these examinations, |
|and should learn how to set up the endovaginal probe. They should also learn the proper technique for disinfecting the probe between studies. |
| |
|Abdominal ultrasound: Second and third year residents should learn to perform emergency scans of the abdomen for indications such as suspected |
|cholecystitis. |
| |
|Testicular ultrasound: Second and third year residents should learn to perform imaging of the acute scrotum for suspected torsion and epididymitis.|
| |
|Guidance for renal biopsies. Second, third and fourth year residents on the ultrasound service should learn to set up the transducer within a |
|sterile drape and with a biopsy guide in order to assist the nephrologists' renal biopsies. |
| |
|Preparing Cases: |
| |
|Studies are reviewed on the KinetDx workstation in the ultrasound reading room. Once a study is reviewed, it should be marked as "Read" on the |
|study list. Brief diagnoses are recorded directly into the KinetDx workstation after the studies are reviewed. |
|The resident should note whether there are prior comparison ultrasound studies. The technologists will often print out the reports of prior |
|studies. If there are prior ultrasound studies, the resident should check whether they are available online for viewing, or whether they need to be|
|re-loaded onto the server manually. If the latter, the resident should note which tape has the study in question and inform the technologists so |
|that they can re-load the study. |
|If there are relevant comparison images from other modalities, these should be brought up onto the PACS workstation in the ultrasound reading area.|
|The resident should note whether there are any outside cases to be reviewed. If so, these should be reviewed on the PACS in the ultrasound reading |
|room. |
|Time allowing, the resident may pre-dictate studies using the Nuance voice recognition software. The studies will then enter status 60, or |
|"dictated." |
| |
| |
|What to do during readout |
| |
|During readout, the resident should articulate the indication for the examination and be able to provide brief patient history. This may mean |
|looking up some history in EPIC before the readout has begun. |
|While the attending reviews the images, the resident should state what his/her impression was of the findings for any cases they have checked or |
|scanned. |
|During the readout, the resident should jot down a brief list of the findings to be included in the dictation on the tracking form for the |
|patient's study so that all findings will be included. The resident should be sure he/she understands what the "bottom line" is for the study |
|BEFORE the case is signed off, so that the report will convey the significance of the findings. Questions are welcome during readout. |
|Conference Schedule/Format |
|Title |Day |Time |Location |
|Abdominal imaging core conferences |Tuesday |Noon |Lucas |
|Ultrasound QA conference |Thursdays |12:30, monthly |Ballroom |
| | | | |
|Method of Assessment of Performance: |
|Written evaluation of resident by responsible faculty member monthly |
|Verbal feedback to resident by faculty |
|ACR In-Training Service Exam annually |
|Recommended Reading |
| |
|ROTATION ONE: |
|Clinical Sonography: A practical guide. Roger A. Sanders. Boston: Little Brown and Co., 1991.This handbook for technologists is a great place for |
|the beginner to start. The book reviews the controls on the ultrasound machine and describes techniques for performing scans. |
|Ultrasound: the requisites. Alfred B. Kurtz and William D. Middleton. St. Louis: Mosby-Year Book, Inc, 1996. An excellent overview of clinical |
|ultrasound. |
| |
|ROTATION 2/3: |
|Sonography of the abdomen. R. Brooke Jeffrey Jr. and Philip W. Ralls. New York: Raven Press, 1995. A rich source of information on abdominal |
|ultrasound, with particularly good images of gastrointestinal applications. |
|Emergency Imaging. R. Brooke Jeffrey, Philip Ralls, Ann Leung, Michael Brant-Zawadzki. Philadelphia: Lippincott Williams and Wilkins, 1999. A |
|concise overview of diagnostic imaging in the acute setting. Chapters 11 and 12 discuss cholecystitis and appendicitis, and are especially |
|pertinent. |
| |
|Reference Text: |
|Diagnostic Ultrasound, Third Edition. Carol M. Rumack, Stephanie R. Wilson, and J. William Charboneau. St. Louis: Elsevier-Mosby, 2005. |
|This outstanding two-volume text contains beautiful color illustrations and has excellent discussions on the most common ultrasound procedures. The|
|first volume covers material likely to be encountered during the Stanford hospital ultrasound rotation. The second volume is devoted to obstetrics |
|and pediatrics. |
| |
|OB ELECTIVE: |
|Ultrasonography in Obstetrics and Gynecology, Fourth Edition. Peter W. Callen. Philadelphia: W. B. Saunders Company, 2000. An in-depth, |
|comprehensive reference on obstetrical and gynecologic ultrasound. Great for boards. |
| |
|Stat DX |
| |
|RadPrimer |
| |
|As a suggestion, you should do selected readings nightly on topics which have come up on cases seen during the day. This is much more effective |
|than reading texts cover-to-cover and, in general, results in better retention of material because you will be able to associate what you’ve read |
|with a real case that you’ve recently seen. |
| |
Appendix A: knowledge objectives in rotation one in preparation for call.
|Pre-call | | | |
| | |1 |Acute Calculous Cholecystitis |
| | |2 |Acute Pyelonephritis |
| | |3 |Biliary Ductal Dilatation |
| | |4 |Choledocholithiasis |
| | |5 |Cholelithiasis |
| | |6 |Deep Vein Thrombosis |
| | |7 |Epididymitis/Orchitis |
| | |8 |Hemorrhagic Cyst |
| | |9 |Hydrocele |
| | |10 |Hydronephrosis |
| | |11 |Hydrosalpinx |
| | |12 |Ovarian Teratoma |
| | |13 |Torsion |
| | |14 |Peripheral Arterial Pseudoaneurysm |
| | |15 |Peripheral Arteriovenous Fistula |
| | |16 |Pyogenic Hepatic Abscess |
| | |17 |Portal Vein Gas |
| | |18 |Scrotal Trauma |
| | |19 |Testicular Carcinoma |
| | |20 |Testicular Torsion/Infarction |
| | |21 |Tubo-ovarian Abscess |
| | |22 |Urolithiasis |
| | |23 |Varicocele |
Appendix B: knowledge objectives for the remainder of the rotations.
|Liver | | | |
| |Diffuse Parenchymal Disease |
| | |24 |Acute Hepatitis |
| | |25 |Cirrhosis, Hepatic |
| | |26 |Diffuse Microabscesses, Hepatic |
| | |27 |Lymphoma, Hepatic |
| |Cyst and Cyst-like Lesions |
| | |28 |Hepatic Cyst |
| | |29 |Caroli Disease |
| | |30 |Amebic Hepatic Abscess |
| | |31 |Hepatic Echinococcus Cyst |
| | |32 |Hepatic Trauma |
| |Focal Solid Masses |
| | |33 |Hepatic Adenoma |
| | |34 |Focal Nodular Hyperplasia |
| | |35 |Hepatocellular Carcinoma |
| | |36 |Hepatic Cavernous Hemangioma |
| | |37 |Hepatic Metastases |
| |Vascular Conditions |
| | |38 |Portal Hypertension |
| | |39 |Portal Vein Occlusion |
| | |40 |Budd-Chiari Syndrome |
|Biliary System | | |
| |Gallstones and Mimics |
| | |41 |Echogenic Bile, Blood Clots, Parasites |
| | |42 |Gallbladder Cholesterol Polyp |
| |Gallbladder Wall Pathology |
| | |43 |Acute Acalculous Cholecystitis |
| | |44 |Chronic Cholecystitis |
| | |45 |Porcelain Gallbladder |
| | |46 |Hyperplastic Cholecystosis |
| | |47 |Gallbladder Carcinoma |
| |Ductal Pathology |
| | |48 |Choledochal Cyst |
| | |49 |Cholangiocarcinoma |
| | |50 |Ascending Cholangitis |
| | |51 |AIDS-Related Cholangiopathy |
|Pancreas | | | |
| |Pancreatitis | |
| | |52 |Pancreatitis, Acute |
| | |53 |Pancreatic Pseudocyst |
| | |54 |Pancreatitis, Chronic |
| |Simple Cysts and Cystic Neoplasms |
| | |55 |Mucinous Cystic Pancreatic Tumor |
| | |56 |Serous Cystadenoma of Pancreas |
| |Solid-Appearing Pancreatic Neoplasms |
| | |57 |Pancreatic Ductal Carcinoma |
| | |58 |Pancreatic Islet Cell Tumors |
| | |59 |Solid and Papillary Neoplasm |
|Spleen | | | |
| | |60 |Splenomegaly |
| | |61 |Splenic Tumors |
| | |62 |Splenic Trauma |
|Urinary Tract | | |
| |Normal Variants and Pseudolesions |
| | |63 |Column of Bertin, Kidney |
| | |64 |Renal Ectopia |
| | |65 |Horseshoe Kidney |
| | |66 |Ureteral Duplication |
| | |67 |Ureteral Ectopia |
| | |68 |Ureteropelvic Junction Obstruction |
| |Calculi and Calcinosis |
| | |69 |Nephrocalcinosis |
| |Cysts and Cystic Disorders |
| | |70 |Simple Renal Cyst |
| | |71 |Complex Renal Cyst |
| | |72 |Cystic Disease of Dialysis |
| | |73 |Multilocular Cystic Nephroma |
| | |74 |Renal Trauma |
| | |75 |Perinephric Fluid Collections |
| |Urinary Tract Infection |
| | |76 |Focal Bacterial Nephritis |
| | |77 |Emphysematous Pyelonephritis |
| | |78 |Pyonephrosis |
| | |79 |Renal Abscess |
| | |80 |Xanthogranulomatous Pyelonephritis |
| | |81 |Tuberculosis, Urinary Tract |
| |Solid Renal Neoplasms |
| | |82 |Renal Cell Carcinoma |
| | |83 |Renal Angiomyolipoma |
| | |84 |Transitional Cell Carcinoma |
| | |85 |Renal Lymphoma |
| |Vascular Conditions |
| | |86 |Renal Artery Stenosis |
| | |87 |Renal Vein Thrombosis |
| |Prostate | | |
| | |88 |Prostatic Hypertrophy |
| | |89 |Prostatic Carcinoma |
| |Bladder | | |
| | |90 |Bladder Carcinoma |
| | |91 |Ureterocele |
| | |92 |Bladder Diverticulum |
| | |93 |Bladder Calculi |
|Renal Transplants | | |
| | |94 |Allograft Hydronephrosis |
| | |95 |Perigraft Fluid Collections |
| | |96 |Allograft Rejection |
|Adrenal Gland | | |
| | |97 |Adrenal Hemorrhage |
| | |98 |Myelolipoma |
| | |99 |Adrenal Cysts |
| | |100 |Pheochromocytoma |
| | |101 |Adrenal Carcinoma |
|Abdominal Wall/Peritoneal Cavity |
| | |102 |Groin Hernias |
| | |103 |Peritoneal Carcinomatosis |
| | |104 |Appendicitis |
| | |105 |Intussusception |
|Female Pelvis | | |
| |Cervical and Myometrial Pathology |
| | |106 |Adenomyosis, General Uterine |
| | |107 |Leiomyoma, General Uterine |
| |Endometrial Disorders |
| | |108 |Hematometrocolpos |
| | |109 |Endometrial Polyp |
| | |110 |Endometrial Hyperplasia |
| | |111 |Endometrial Carcinoma |
| | |112 |Endometritis |
| |Pregnancy-Related Disorders |
| | |113 |Ectopic Pregnancy |
| | |114 |Interstitial Ectopic Pregnancy |
| | |115 |Failed First Trimester Pregnancy |
| | |116 |Retained Products of Conception |
| | |117 |Gestational Trophoblastic Neoplasm |
| |Ovarian Cysts and Cystic Neoplasms |
| | |118 |Functional Ovarian Cyst |
| | |119 |Ovarian Hyperstimulation |
| | |120 |Serous Ovarian Cystadenoma/Carcinoma |
| | |121 |Mucinous Ovarian Cystadenoma/Carcinoma |
| | |122 |Polycystic Ovarian Syndrome |
| |Non-Ovarian Cystic Masses |
| | |123 |Parovarian Cysts |
| |Vaginal and Vulvar Cysts |
| |Miscellaneous Ovarian Masses |
| | |124 |Ovarian Fibrothecoma |
| | |125 |Endometriomas |
|Scrotum | | | |
| | |126 |Undescended Testis |
| | |127 |Testicular and Epididymal Cysts |
| | |128 |Testicular Microlithiasis |
| | |129 |Tubular Ectasia |
| | |130 |Epididymal Masses |
|Head and Neck | | |
| |Thyroid and Parathyroid |
| | |131 |Differentiated Thyroid Carcinoma |
| | |132 |Hashimoto Thyroiditis |
| | |133 |Multinodular Goiter |
| | |134 |Graves Disease |
| | |135 |Parathyroid Adenoma, Visceral Space |
| | |136 |Anaplastic Thyroid Carcinoma |
| |Adenopathy | |
| |Salivary Glands |
| |Parotid Space | |
| |Miscellaneous Lumps |
| |Congenital | |
|Breast | | | |
|Musculoskeletal | | |
| |Tendon Disorders |
| |Subcutaneous and Muscle Injury |
| |Arthropathies | |
| |Neurovascular Abnormalities |
| |Infection | | |
| |Articular and Para-Articular Masses |
| |Soft Tissue Tumors |
|Vascular | | | |
| |Cerebrovascular |
| | |137 |Carotid Stenosis/Occlusion |
| | |138 |Vertebral Stenosis/Occlusion |
| |Abdominal Vessels |
| | |139 |Takayasu Arteritis |
| | |140 |Aortic/Iliac Aneurysm |
| | |141 |Aorto-Iliac Occlusive Disease |
| | |142 |IVC Obstruction |
| |Extremities | |
| | |143 |Subclavian Steal |
| | |144 |Varicose Veins/Incompetent Perforator |
|Liver Transplants | | |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- pathway guide ovarian cysts general information
- hemorrhagic pancreatic pseudocyst presenting as
- acute appendicitis and hemorrhagic ovarian cyst in a
- hemorrhagic liver cyst rupture an unusual life
- treatment of hemorrhagic hepatic cysts with omentalization
- how to manage ovarian cyst
- ayurvedic management of hemorrhagic ovarian
- cirriculum vitae
- gynecology al mustansiriya university
Related searches
- hackensack university medical center jobs
- hackensack university medical center intr
- hackensack university medical center dire
- hackensack university medical center map
- hackensack university medical center billing
- hackensack university medical center email
- hackensack university medical center my chart
- hackensack university medical center directory
- hackensack university medical center records
- hackensack university medical center medical records
- stanford university medical center physicians
- stanford university medical center