Residency Competency Evaluation: Double Contrast Upper Gastrointestinal Series

Residency Competency Evaluation: Double Contrast Upper Gastrointestinal Series

Resident: ______Date: ______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of double contrast UGIs performed:_____

Average fluoroscopy time: _____

ATENDING EVALUATION

 Appropriate use of intravenous glucagon MK1

 Appropriate use of barium MK1

Appropriate images obtained to answer the clinical question PCTS2

 Projections

 Distension

 Coating

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2

Residency Competency Evaluation: Pharyngoesophagram

Resident: ______Date:______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of pharyngoesophagrams performed:_____

Average fluoroscopy time: _____

ATENDING EVALUATION

 Appropriate use of effervescent agent MK1

 Appropriate use of barium MK1

Appropriate images obtained to answer the clinical question PCTS2

 Projections

 Magnification factors

 DVD recording

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2

Residency Competency Evaluation: Small bowel follow-through

Resident: ______Date: ______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of small bowel follow-throughs performed:_____

Average fluoroscopy time: _____

ATENDING EVALUATION

 Appropriate use of barium MK1

Appropriate images obtained to answer the clinical question PCTS2

 Esophagus and Stomach

 Small intestine

 Projections

 Prone

 Lateral

 Appropriate use of magnification

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2

Residency Competency Evaluation: Single contrast enema

Resident: ______Date:______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of single contrast enemas performed: _____

Average fluoroscopy time: _____

ATENDING EVALUATION

 Appropriate use of intravenous glucagon MK1

 Appropriate use of barium or Gastrografin MK1

Appropriate images obtained to answer the clinical question PCTS2

 Compression

 Projections

 Post-evacuation images

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2

Residency Competency Evaluation: Fistulagram

Resident: ______Date:______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of fistulagrams performed:_____

Average fluoroscopy time:______

ATENDING EVALUATION

 Appropriate contrast agent MK1

 Appropriate use of catheter PCTS2

 Appropriate images obtained to answer the clinical question PCTS2

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2

Residency Competency Evaluation: Rule out upper gastrointestinal tract leak

Resident: ______Date: ______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of “rule out leaks” performed: _____

Average fluoroscopy time: _____

ATENDING EVALUATION

 Appropriate use of Gastrografin or barium MK1

 Appropriate images obtained to answer the clinical question PCTS2

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2

Residency Competency Evaluation: Postoperative colonic study

Resident: ______Date: ______Months of experience in GI:_____

RESIDENT SUPPLIED INFORMATION

Number of post-operative colonic surgery studies performed: _____

Average fluoroscopy time: _____

ATENDING EVALUATION

 Appropriate use of intravenous glucagon MK1

 Appropriate use of Gastrografin MK1

 Appropriate images obtained to answer the clinical question PCTS2

 Reasonable fluoroscopy time PBLI1

Dictation using the following elements ICS2

 Procedure performed

 Pertinent clinical history in addition to given history

 Findings/Narrative

 Radiological Diagnosis/Conclusion

SUMMERY:

The trainee performed these procedures

Appropriate for level of training PCT2

Or

Competently and independently PCT2