PART II: DI Fellow Orientation
PART II
6.0Fellow Expectations and Evaluation...... 28
6.1Credentialling Requirements...... 28
6.2Rotations: Expectations...... 28
6.2.1CT/Wards...... 28
6.2.2GI/GU/NICU...... 29
6.2.3OPD...... 29
6.2.4Ultrasound...... 29
6.2.5MRI...... 29
6.2.6Neuro...... 30
6.2.7Cardiac...... 30
6.2.8Elective...... 30
6.3Reporting Expectations...... 30
6.4Rounds...... 31
6.5On-Call Expectations and Responsibilities...... 31
6.6Evaluation...... 32
6.7Academic Time...... 33
6.8Vacation/Conference Requests...... 33
6.9Code Orange - External Disaster...... 33
7.0Teaching Files and Research...... 35
7.1Teaching Files, Radiology Medical Books and Journals...... 35
7.2Projects and Research...... 35
7.3Research Policy and Procedures (HSC)...... 35
8.0Appendices...... 36
8.1Mission Statement Day: The impact on medical students of an early exercise in professionalism. 36
6.0Fellow Expectations and Evaluation
6.1Credentialling Requirements
In order to be qualified to sedate a child, Fellows will be provided a sedation course and a separate sedation policy and procedure manual. The Fellows will be expected to complete a course in BCLS, which will be arranged through our department. Proof of completion of this course will be required.
6.2Rotations: Expectations
In general, each daily clinical rotation will begin promptly at 9:00 a.m. after the completion of the 8:00 a.m. rounds if they are scheduled. If there are no 8:00 a.m. rounds, clinical rotation will begin at 8:00 a.m. During rotations which require primarily plain film reporting, separate PACS workstations have been constructed and dedicated to specific types of film reading. These will be shown to you. PACS workstations primarily designed for emergency examinations and out-patient clinic films will be read in designated PACS workstations in “Atrium Imaging”. The in-patient films will be read primarily in workstations dedicated to PICU and in-patient reporting in the reporting area behind GI/GU on the second floor of the Elm Wing. At each workstation, baskets will contain requisitions which will need to be reviewed. Baskets are marked as to requisitions which will need to be dictated and upon film review and dictation, the requisition sheet will be then transferred to a separate basket marked “requisitions to be filed”. When each film is read, it is marked at that time as dictated (F6) and the photomarker is removed for the transcriptionists. Your signature as well as the name of the responsible staff radiologist who reported the film with you will be placed on the requisition as you will be shown during your initial training session. Since part of your role is to teach our rotating radiology residents, each days work can be divided between yourself and a resident, if one has been assigned to your rotation. As you become more experienced, you will be expected to monitor and help supervise their work as well.
6.2.1CT/Wards
During this rotation, the in-patient cases will be read throughout the day as they are performed the requisitions are placed in the “to be dictated” basket. The images will be reviewed with you by a staff radiologist after you have initially reviewed the examinations and prepared them for review. Throughout the day you will be paged to perform and monitor ongoing CT examinations. These will be reviewed with the staff radiologist as well before your dictation. It is your responsibility to review requisitions for in-patient and out-patient body CT examinations with the staff radiologist and to grade them appropriately so that they can be booked accordingly.
6.2.2GI/GU/NICU
The first cases may begin before 9:00 a.m. in the GI/GU area and these will be started by a staff radiologist. Your responsibilities in this area will begin as soon as the 8:00 a.m. rounds are completed. If there are no 8:00 a.m. rounds your responsibilities begin at 8:00 a.m. The Fellow will work with a staff radiologist assigned to the GI/GU area each day. All cases are to be reviewed with the staff radiologist before the patient ispermitted to leave the department. Voiding cystourethrograms are now primarily performed by technologists. You are however responsible to perform some of these procedures so that you learn to perform these comfortably on your own. During this rotation as well, the NICU studies will be reviewed at the PACS workstation by yourself in conjunction with the staff radiologist. These will be dictated by yourself.
6.2.3OPD/ER
The Fellow on this rotation is to go to Atrium Imaging, (Ground floor of the newer building) to read out-patient clinic films with the staff radiologist assigned to OPD on the staff roster. The Fellow should first review the films followed by review with the staff radiologist assigned to that area. As out-patient clinic or emergency room films are performed, you will be asked to review and dictate them with the staff radiologist assigned to “OPD” on the staff roster. This rotation is also quite busy but it is here that you will learn most of your important plain film interpretations. You are again requested to start immediately after morning rounds, and to dictate your films in an expeditious manner. This Fellow will remain “on call” to the ER for consultation during the day. Most days there will be a radiology resident reviewing the ER cases from the night before. As well, a radiology resident may be in on “OPD” rotation, who will receive the on call beeper at 8:00 a.m. from the resident on call the night before and carry it during the day for consultations and traumas.
6.2.4Ultrasound
During this rotation, you are to be available to review and scan patients all day, excluding rounds. You may be sharing these responsibilities with a resident. All cases are first scanned by a technologist, and then presented to the physician for review. The technologists in this department are very experienced at scanning children, so you should ask them for help when necessary. Each day, one technologist goes to the NICU to scan newborn/prematures. You are encouraged to join them.
6.2.5MRI
During this rotation, the Fellow is expected to be available to monitor body MRI examinations, as well as to review these examinations for dictation. There is no set time for review of these cases. The best approach during this rotation is to confer with the Staff in the morning to coordinate the day. You should be aware that the staff radiologist assigned to MRI each day is also responsible for OPD, and may spend a good deal of time there, depending on the number of body MRI scans that are booked for that day. When there are no MRI examinations to be listed/monitored, this Fellow will go to OPD to help review clinic films.
6.2.6Neuro
Your responsibilities will be primarily in monitoring the head CT’s and/or MRI’s as they are being done, and reviewing the cases with a staff radiologist so they can be dictated. The neuroradiology section reviews their CT’s at 9:00 a.m. and 4:00 p.m. and their MRI’s at 10:30 a.m. and 4:00 p.m. daily. The 4:00 p.m. session may interfere with some of your rounds and you should try to plan to review your cases accordingly.
6.2.7Cardiac
Your primary responsibility will be reviewing in-patient and out-patient cardiac plain films as well as the PICU examinations. The rotation will include reviewing cardiac angio’s and MRI’s as well. There is also limited exposure to fetal echocardiography. There are various cardiac conferences that you are invited to attend.
1.1IGT
Your primary responsibility will be to be actively involved in the case lists in IGT, consults and ward rounds, depending on the roster of the day. The fellows should be present in IGT at 7.35 AM for consent to start the day’s list at 8.00AM. The day finishes when the last case is completed and the patients have all been seen on the ward post procedure. Clinical follow up must be entered into the IGT Database by the fellow. A full description is available electronically on the IGT web and in a Fellows Guide to IGT available on a computer within IGT.
6.2.9Elective
Elective time is provided for you to spend in whatever area of the Department you would like. Please arrange this in advance with the Chief Fellow.
6.3Reporting Expectations
Our department, at the current time, functions on a tape dictation system where dictaphones are issued throughout the department and tapes are available from the transcriptionists. You will be instructed on what information to include in each dictation however the patient’s name and the “Accession number” are the most important (see section 10.0 on Dictation). As well it is critical that you begin each transcription tape with you name, the date and with which Staff Radiologist you are dictating with. At the completion of your dictation session we expect you to hand in your tape promptly to the transcriptionists so that these can be transcribed within a timely fashion. Our department maintains an expectation of 24-hour report turn around time. Therefore, within several hours your dictation should be ready to be signed off on Cerner and it is expected that you edit, correct and sign all your reports by the end of each day. It is critical that you perform this in a timely fashion as our current system makes your preliminary report (before editing), available to the clinicians. It is available to them only as a preliminary report. However if you edit it in a timely fashion it will be sent to the Radiologists queue who will also edit it in a timely fashion and a final report will be sent out. Should the Radiologists disagree with you, he or she may reject it and it will be returned to your queue with a note. Should you have any concerns about this process or your reports please contact the Staff Radiologist responsible for your session who can help you.
6.4Rounds
There is a central core of departmental teaching rounds as noted on the rounds schedule. You are expected to be present on time at these rounds and you will be freed of clinical responsibilities at these times. There are a series of radiological-clinical correlation rounds with various services at various times during the week (see rounds schedule). Every attempt within reason will be made to enable you to attend these rounds. At times, however, some of our rotations are so busy that you may need to complete your work before you go. You may be expected to present the pertinent case at these rounds after appropriate review with a Staff Radiologist.
6.5On-Call Expectations and Responsibilities
Each night there are several physicians on-call covering the various areas of the department. An on-call roster is circulated at the beginning of each month. There is a staff member on-call for body imaging, a separate staff member for neuro imaging, a separate staff member for interventional procedures and a separate staff member for Nuclear Medicine procedures. The fellow on-call may be responsible only for the body imaging or may be responsible for both the body and neuroradiologic imaging for the evening. On the vast majority of nights, there will be an in-house resident who is responsible on a first call basis for accepting requested studies. That resident will communicate with you each and every procedure that will have to be performed. Depending on the experience of that resident and depending on your experience, the resident may be permitted to perform at least part if not all of the procedure under your direct supervision. If however the resident is inexperienced it will be your responsibility to perform the procedure appropriately.
During the first few weeks to months of your fellowship, these procedures will be performed in conjunction with a staff Radiologist who will administer hands-on supervision. This will be performed until such a time as you are deemed capable and comfortable with performing procedures without direct hands-on supervision. You must be aware that at all times the staff Radiologist on call is available for any level of supervision that you would request. At the beginning of your fellowship you will be provided with a list of common procedures that are usually performed on-call on children. As your fellowship proceeds, you will perform these procedures with direct staff supervision early in the course of your fellowship. As you prove proficiency at understanding and performing these procedures, you will ask each staff member to sign a sheet of paper with their signature witnessing your proficiency. After three staff members have witnessed your examinations and signed the sheet appropriately, you will be deemed to be capable of performing these procedures without the physical presence and supervision of the staff member. Never hesitate to call the radiologist on call, if you feel you need to.
For IGT fellows, please refer to the electronic Fellows Guide to IGT available in IGT. The staff comes in for every case. Always call the staff for any consultation about a potential procedure or booking. Booking of GA cases is done through the OR desk at x 6049. The nurse and technologist need to be called in for each and every case. Allow 45 minutes – 1 hour for travel time for the team. A check list of items necessary when arranging a case for on call is available on the electronic guidelines. It includes: name, age, diagnosis, ward, procedure to be done, fasting status, CBC and coagulation profiles where needed, and parent availability for consent. Ward rounds are done daily including Saturday and Sunday, at a time chosen between you and your staff. Do not hesitate to call the staff, day or night, with any queries.
Your in-house presence is not required when there are no ongoing procedures during the nights and weekends where a resident is present in-house. However, you must be available to be accessible to the hospital within 20-30 minutes. Your pager must remain operational and you must answer your pages promptly. You should also be aware that as part of your training, you will be expected to teach the on-call resident appropriately as your level of experience advances. On-call responsibilities begin at 5:00 p.m. on weekdays and last until 8:00 a.m. the next day. On weekends the on-call responsibilities begin at 9:00 a.m. and proceed until 9:00 a.m. the next day. All changes or switches on the on-call rotation are to be cleared with the Chief Fellow and recorded on a master schedule kept in the main radiology forum. Although your on-call responsibilities are completed at 9:00 a.m. the next day, it is still your responsibility to review the cases you have performed the day before with the staff radiologist on-call with you that day and to dictate those cases with that staff radiologist. This review on weekends is usually performed in the morning of the next day. This review can be co-ordinated between yourself and the staff radiologist.
6.6Evaluation
The review of your clinical skills and reports will be an on-going process, under direct supervision of the staff Radiologists with which you will rotate throughout your fellowship. Evaluation of the fellows/fellowship program is performed on a semi-annual basis. After 6 months of training, the new fellows get an evaluation session a member of the Fellowship Program Committee reviewing the clinical progress, the academic progress. A series of multiple choice questions (true/false type) is proposed and 4 clinical cases are discussed by the fellow. On a 6-month basis, the staff members are asked to provide a fellow evaluation (completing a fellow evaluation form). This will also give you an opportunity to provide verbal feedback concerning the rotations and the staff teaching. The finishing fellows meet with Dr. S. Miller at the end of their training to review the progress in clinical/academic fields and discuss general/specific points of the training program.
7.7Academic Time
Academic Time is given to the fellows for pursuit of academic activities which include preparation of publications, research projects and teaching files as well as advancing the clinical activities of the Department. Academic time should not be used for provision of clinical services. Generally, academic time is given to each fellow on a weekly basis with one day set aside for pursuit of academic activities. These activities should be undertaken within the Department. It is to be understood that academic time may occasionally need to be set aside if urgent clinical duties require. However it is also to be recognized that staff should not abuse this privilege and ensure academic time is available to the fellows.
The fellows are expected to use this academic time wisely with significant output. Staff are available to guide the fellows in their academic activities either on a direct basis if involved with a combined project or to provide general guidance overall in terms how best to get started. Many staff have projects available to the fellows and can ensure that they have a productive academic time. All fellows are required to write at least one original manuscript in each year that they are registered in the program. This is in order to fulfill the academic requirements of a Fellowship in our Department. It is also the expectation that fellows prepare at least one hour long lecture during their time here at the resident/fellow level for each year spent in the fellowship.
7.8Vacation/Conference Requests
You will be entitled to 4 weeks of vacation per year, however, this vacation time cannot be taken over the Christmas/New Years period. However additional discretionary leave may be granted during this time depending on the length of the period as well as the number of fellows in department at that time. You cannot take any vacation time two weeks prior to the end of your fellowship.