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  • 1. 1 DEPARTMENT OF DIAGNOSTIC IMAGING RHODE ISLAND HOSPITAL BROWN MEDICAL SCHOOL RESIDENCY MANUAL Initial Formulation: 1984 Most Recent Review/Revision: June 2004

2. 2 PHYSICIANS IN CHARGE OF SECTIONS Chairman John J. Cronan, M.D. Program Director Martha B. Mainiero, M.D. Physician in Charge CT William Mayo-Smith, M.D. ER Thomas K. Egglin, M.D. Fluoro Brian L. Murphy, M.D. Nuclear Medicine Richard B. Noto, M.D. Musculoskeletal Robert E. Lambiase, M.D. Pediatrics Michael T. Wallach, M.D. Cardiopulmonary Gerald F. Abbott, M.D. Physics Douglas R. Shearer, Ph.D. Vascular & Interventional Gregory M. Soares, M.D. Ultrasound Damian E. Dupuy, M.D. Breast Imaging Barbara Schepps, M.D. Women & Infants' Patricia K. Spencer, M.D. Neuroradiology/MRI Jeffrey M. Rogg, M.D. Medical Office Complex Scott M. Levine, M.D. The Miriam Hospital/MRI Richard L. Gold, M.D. Research Glenn A. Tung, M.D. 3. 3 RESIDENCY MANUAL TABLE OF CONTENTS I. GENERAL INFORMATION Page 3-32 A. Selection Policy Page 4 B. Lines of Supervision Page 5 C. Evaluation Policy Page 5-11 D. Formal Grievance Procedures Page 6 E. Noon Conference Curriculum Page 12-22 F. Imaging Conference Page 22 G. New England Roentgen Ray Society Meeting Page 23 H. Self-Study Page 23 I. Research Page 24 J. Call Responsibilities Page 25 K. Duty Hour Policy Page 26 L. Vacation Policy Page 26 M. Leaves of Absence Page 27 N. Moonlighting Page 28 O. Report on Pregnancy Page 29 P. Hospital Leave Page 30 Q. ACLS Certification Page 30 R. Duties of the Chief Resident(s) Page 31 S. Faculty Appointments Page 32 II. ROTATIONS: HOURS, GOALS, OBJECTIVES AND READING LISTS A. Conscious Sedation Policy Page 37-41 B. Computed Tomography Page 42-63 C. Emergency Department Page 64-71 D. Fluoroscopy/Gastrointestinal/Genitourinary Page 72-78 E. Nuclear Medicine Page 79-86 F. Musculoskeletal Radiology Page 87-92 G. Pediatrics Page 93-97 H. CardiopulmonaryRadiology Page 98-104 I. Physics/Radiobiology Page 105-107 J. Vascular & Interventional Radiology Page 1108-119 K. Ultrasound Page 120-125 L. Breast Imaging Page 126-130 M. Women & Infants Page 131-137 N. AFIP Page 138 O. Elective Page 139 P. Neuroradiology/MRI Page 140-154 Q. Medical Office Complex Page 155-160 R. TMH/MRI Page 161 4. 4 RESIDENT SELECTION POLICY Resident applications are accepted through ERAS, and interviews are granted after review of medical school transcript, letters of recommendation, personal statement and USMLE scores. After receipt of the Deans letter, two members of the education committee interview each applicant, and all interviewed applicants are discussed among and ranked by the members of the education committee. The rank list is then submitted to the NRMP. Decisions regarding selection for interview and rank order are made without regard to the applicants race, sex, creed, ethnic background or national origin. DRESS At all times the residents should dress in a manner fitting the professional position he or she has attained. Weekend dress should be similar to weekday. TELEPHONE ETIQUETTE It is appropriate that you identify yourself and the section in which you are working. Remember at all times to be courteous, patient and helpful. REPORT SIGN-OFF On arriving to work in the morning, at noon, and finally prior to leaving, the resident should read, correct, and electronically sign all of his/her transcribed radiology reports. It is absolutely essential that this task be completed in an expeditious manner. THE FOUR-YEAR CURRICULUM The four-year training program in diagnostic imaging is a competency-based curriculum with the goal to proportion residency training to conform to the contemporary practice of diagnostic imaging (Table I). The clinical program has been designed so that the resident will spend time optimally distributed through the areas involved in medical imaging and interventional radiology. In the first year the resident's time is distributed in those areas in which s/he must become acquainted to become competent in basic radiology skills. These clinical rotations include GI/GU fluoroscopy, emergency radiology, bone radiology, chest radiology, nuclear medicine, ultrasound, computed tomography (CT), pediatric radiology, vascular and interventional radiology, and obstetrical sonography and MRI. In the second, third, and fourth years of training in radiology, the distribution is such that the resident will spend approximately one additional month in each area each year including mammography. An elective at the Armed Forces Institute of Pathology (AFIP) is possible in the third year. At least one additional elective month is available in the third and fourth years. Electives can be spent in a number of useful and innovative ways to refine the resident's skills and to explore new career possibilities. During the second and third years it is expected that the resident will progressively move closer to the goal of being able to run the clinical section, an ability expected of all the fourth year residents. 5. 5 Upon completion of the program, the resident physician will be a competent, well-rounded diagnostic imager and will be competent in basic angiographic and interventional techniques. It is felt that the four-year residency program is not a time for subspecialization; intensive subspecialty training is the purview of a fellowship program. POLICY ON LINES OF SUPERVISION Upper level residents and fellows may at times supervise residents, but faculty members are ultimately responsible for the clinical care given to patients. Residents will be given increasing responsibility during the four-year curriculum, with appropriate levels of faculty supervision at all times. At all levels of training, cases must be reviewed by an attending radiologist before report sign-off. Interventional procedures must be supervised by an attending radiologist. Toward the end of the first year of training, residents will take an examination to assess competency for taking independent overnight call. Only after successful completion of the examination will 2nd year residents begin to function as the in-house radiologist after 11pm. Fellows and attendings take call from home to assist the resident, including coming into the hospital to review cases and perform procedures when necessary. The weekly attending/fellow schedule lists who is on call for general radiology, pediatric radiology, VIR, and MRI. Residents are encouraged to contact the fellow or attending staff at anytime when assistance is needed. The appropriate person should be paged or called at home. Pager numbers are provided through the Lifespan intranet and home phone numbers are provided by the department. Home phone numbers should be kept confidential. If the responsible individual cannot be reached for any reason, the resident should call any other faculty member necessary for assistance. EVALUATION OF PERFORMANCE It is necessary that a residency-training program establish minimal standards of acceptable performance, which will be used to determine advancement as well as to commend above average achievement. The written evaluation is essential to the regular assessment of resident performance. Following the completion of each monthly rotation, the teaching faculty will complete an evaluation form (Table II). Evaluation is based upon the residents performance in achieving the stated goals and objectives in the six general competencies for each rotation at each level of training. These six general competencies are defined by the Accreditation Council for Graduate Medical Education (ACGME) as follows: medical knowledge, patient care, professionalism, interpersonal and communication skills, problem-based learning and systems-based practice. In addition, on services where there is interaction with the technical staff, the lead technologist will evaluate the residents on professionalism and interpersonal and communication skills (Table III). In addition, we are piloting a program to have the Emergency Department physicians evaluate the residents performance in the six general competencies while on the night float rotation (Table IV). The evaluation form will become a permanent part of the resident's record. All written evaluations are available for review by the resident at any time. It is expected that the resident will contact the attending responsible for formulation of the written evaluation if concerns are raised. This semi-annual review will be performed with the resident and competency in the six general competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME) will be assessed. These six areas are medical knowledge, patient care, professionalism, interpersonal and 6. 6 communication skills, problem-based learning, and systems-based. The resident is responsible for maintaining a procedure log for all non-vascular procedures on an excel spreadsheet, which will be provided by the chief residents. The resident must bring this log to every semi-annual review. The log of procedures kept by the vascular and interventional computer system (HIQ) should also be printed and brought to the review. This review will become a part of the permanent record. The American College of Radiology (ACR) written "in-service" examination is required of all first, second and third year residents. This examination is given in February and the results are received and will be received approximately six weeks later. A mock oral board examination will be given to third and fourth year residents several weeks after the written board examination. For the fourth year residents, this practice run will help in preparation for the oral board examination given by the ABR in June. For the third year residents, this experience should further refine and coalesce the knowledge and organization of thought that the resident has acquired over the years. At six-month intervals, i.e., in December and June, the resident's overall pe