va nuclear medicine rotation description

rotation overview

The Nuclear medicine rotation at the VA Medical Center requires a minimum of two months. Residents gain a wide range of knowledge and skill in various aspects of nuclear medicine, PET/CT, and molecular imaging.

During this rotation, residents receive training in the following subspecialties:

  • Nuclear Medicine

(Additional training in Nuclear Medicine occurs on the two-month UMNM rotation. Some residents will have a third rotation at the University.)

Requirements are progressive and cumulative over time. That is, a resident in the 2nd or 3rd month of the rotation is assumed to continue to meet all the goals and objectives of the 1st month of rotation. The responsibilities and privileges that apply at the end of the 1st month rotation will continue to apply in subsequent months.

Didactics

  • Complete minimum reading requirements specified in the Body of Knowledge, as indicated in the Section Description for Nuclear Medicine.
  • Participate in conferences and rounds as described in the VANM Duty Sheet. All residents will be responsible for presenting cases in conference.
  • Wednesday evening lecture series
  • Participate in conferences as directed by VA staff

clinical activities

  • Participation in wide range of diagnostic and image-guided procedures, as noted in the specific objectives listed below under the core competencies.

ROTATION GOALS

Upon completion of the VANM rotation, resident will:

  • Demonstrate mastery of the Body of Knowledge, as defined in the Section Curriculum Description for Nuclear Medicine.
  • Achieve “Competency” in each category evaluated by faculty evaluations through RMS system.
  • Consistently meet the expectation outlined in the VANM Duty Sheet.
  • Give the 30-minute presentation described in the Duty Sheet.

If a resident should do a third month in nuclear medicine at the VA, please see the UMNM rotation description for additional third-month objectives.

COMPETENCIES & OBJECTIVES

Goals are listed as bullets under each competency below. Each goal is followed by a list of objectives for each year (unit) of the complete rotation, along with the appropriate assessment tool for each objective. Evaluation codes, A, B, C, etc. refer to the Evaluation Methods and are described in more detail in the Appendix.

A: Global Faculty Evaluation; B: Case/Procedure Logs; C: 360 Degree Evaluation; D: Objective Test; E: Resident Learning Portfolio; F: Document participation in Department Activities; G: Evaluation quality of reports; H: Direct Observation and I: Journal Club

PATIENT CARE

Develop a management plan based on radiologic findings and clinical information

MO / Objective description / evaluation method
1 /
  • Understands basic function in Nuclear Medicine including gamma camera quality control, design, functional uses, SPECT and gated principles
  • Understand basic Nuclear Pharmacy as it applies to routine day to day in the Division of Nuclear Medicine
  • Understand basic Nuclear Medicine procedures and indications
/ a,b
2 /
  • Understand cardiac applications of Nuclear medicine including, stress perfusion, MUGA evaluation and PET Viability
  • Understand Nuclear Endocrine (Thyroid, Adrenal, Parathyroid) management, diagnosis and therapy
  • Understand Advanced PET/CT/MRI diagnosis of Oncological and Nuerological Nuclear Medicine
  • Understand Molecular Imaging Diagnosis as it relates to patient care
/ a,b

MEDICAL KNOWLEDGE

(Residents should be knowledgeable, scholarly and committed to lifelong learning)

recognize and describe relevant radiologic abnormalities

MO / Objective description / evaluation method
1 /
  • Be able to articulate physical, chemical and biological properties of radiopharmaceuticals used in Nuclear Medicine and Molecular Imaging
  • Be able to describe daily QC of gamma cameras, SPECT acquisitions and processing, and gamma camera design and function
  • Understand the imaging/pathologic correlation in nuclear medicine procedures (i.e., bone, hepatobiliary, renal, gastric emptying, thyroid imaging and function)
  • Be able to articulate the four basic aspects of Molecular Imaging and Diagnosis
/ a,d
2 /
  • Be able to articulate the PET/CT principles, clinical applications, QC procedures and analysis of results
  • Be able to manage patients with Thyroid disease (i.e. hyperthyroidism, Cancer, low/high dose therapies)
  • Be able to assist referring physicians in the staging and management of Oncological Imaging (PET/CT, Nuclear Medicine)
/ a,d,h

synthesize radiologic and clinical information and form an impression

MO / Objective description / evaluation method
1 /
  • Know the normal appearance and behavior of commonly used radiopharmaceuticals.
  • Be able to identify abnormal findings on nuclear medicine examinations
  • Know common artifacts which may alter the appearance on procedures
  • Be able to formulate a consultative conclustion based on the abnormal findings
/ a,d
2 /
  • Be able to more extensively formulate a consultative conclusion based on the abnormal findings
/ a,d

utilize information technology to investigate clinical questions and for continuous self-learning.

MO / Objective description / evaluation method
All /
  • Demonstrate use of internet to find pertinent information to add to current cases and teaching file cases.
  • Demonstrate case based computer initiated biomedical library and internet information access.
  • Be able to use the VA Nuclear Medicine work station for study interpretation
/ a,d

INTERPERSONAL/COMMUNICATION SKILLS

(Residents should communicate and teach effectively)

show sensitivity to and communicate effectively with all members of the health care team

MO / Objective description / evaluation method
1 /
  • Interactions with team members are in accordance with the VANM Duty Sheet.
  • Residents interact effectively and appropriately with both patients and families.
  • Communicate effectively with referring physicians
/ a,c,g,h
2 /
  • Explain the role of the radiologist as a team member in managing patients with medical conditions necessitating nuclear medicine procedures
/ a,c,g

appropriately obtain informed consent

MO / Objective description / evaluation method
1 /
  • Demonstrate knowledge of principles of informed consent, and appropriate documentation of such.
/ a,c,g
2 /
  • Consistently obtain appropriate informed consent with appropriate documentation
/ a,c,g

Recognize, appropriately communicate, and document in the patient record urgent or unexpected radiologic findings

MO / Objective description / evaluation method
All /
  • Consult with Nuclear Medicine staff when unexpected and care changing findings are discovered
  • Unexpected abnormal and care changing findings should be reported within 1 hour to ordering physician or care team and recorded in the report of the examination
  • Consule Interventional Radiology as soon as active GI Bleeding is observed on a Nuclear Medicine GI Bleeding examination
  • Know NRC rules for reporting “spills” and “Misadministration”
/ a,c,g,h

Produce radiologic reports that are accurate, concise, and grammatically correct.

MO / Objective description / evaluation method
1 /
  • Effectively communicate the radiological findings in both oral and written format
  • Reports exhibit internal consistency
  • Use “Power Normal” reports as much as possible for consistent and complete reporting of findings and conclusions
/ a,c,g
2 /
  • Reports evolving further into radiological consultation with concise but accurate differential diagnosis’ and pertinent references
/ a,c,g

Effectively teach residents, medical students and other health care professionals.

MO / Objective description / evaluation method
1 /
  • Produce three teaching files per rotation and give case conferences as scheduled.
  • Prepare multidisciplinary conference cases, adding 3 cases occurring during rotation to the appropriate saved folder for potential teaching file cases
  • Teach previously mastered competencies to medical students and more junior residents.
/ a,c,g,h
2 /
  • Give the 30-minute presentation described on the Duty Sheet.

PRACTICE-BASED LEARNING AND IMPROVEMENT

(Residents should investigate and evaluate patient care practices, and appraise and assimilate scientific evidence in order to improve their practices)

participate in qi (quality improvement)/qa (quality assurance) activities

MO / Objective description / evaluation method
All /
  • Demonstrate understanding of Quality Assurance process.
  • Actively participate in identifying errors, improving quality of the image and its interpretation, and forwarding the results to the Quality Assurance Committee.
/ a,e

Recognize and correct personal errors

MO / Objective description / evaluation method
all /
  • Consistently use personal errors and feedback on errors to improve performance.
  • Apply strategies for elimination of errors recognized by Quality Assurance Committee.
  • Use printed and electronic resources to access information that can further the individual’s knowledge and further the care of the patient.
  • Identify personal errors and develop strategies for their elimination
/ a,e

PROFSSIONALISM

(Residents should be altruistic and accountable, and adhere to principles of medical ethics by respecting and protecting patient’s best interest)

Demonstrate a responsible work ethic with regard to conference attendance and work assignments

MO / Objective description / evaluation method
all /
  • Comply with VANM Duty Sheet requirements for conferences and teaching files.
  • Uphold work ethic described on the VANM Duty Sheet.
  • Demonstrate respect for patient privacy and confidentially.
/ a,c,h

Demonstrate acceptable personal demeanor and hygiene

MO / Objective description / evaluation method
1 /
  • Comply with standards for professional appearance and conduct as outlined in the VANM Duty Sheet.
/ a,c,h
2 /
  • Assume greater responsibility, in interactions with personnel in the work environment, for maintaining a respectful work environment.
/ a,c,h

SYSTEMS-BASED PRACTICE

(Residents should understand healthcare practice)

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

MO / Objective description / evaluation method
1 /
  • Attend interdisciplinary conferences.
  • Demonstrate understanding of electronic medical records, including PACS and its integration
  • Know the ACR standards of appropriateness criteria.
  • Demonstrate understanding of and consistent practice of radiation safety.
  • Weigh, on a daily basis, the pros and cons in terms of health care costs, and appropriateness, of alternative forms of diagnostic imaging work up on individual patients
/ a,e,f
2 /
  • Correctly apply ACR standards/appropriateness criteria.
  • Develop understanding of cost effective algorithms for patient care.
/ a,e,f