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RADIOLOGY
RESIDENT
MANUAL
SECTION 2 - Contains goals and objectives for the PGY1 year of basic clinical training.
SECTION 3 - Contains rotation specific clinical radiology goals and objectives to be achieved
during rotations at various levels of training. These objectives form the basis of rotation evaluations.
All residents should familiarize themselves with the contents of SECTION 1. First year residents
should review Section 2. Residents should review appropriate parts in SECTION 3 before each
radiology rotation and referred to throughout the rotation.
COPYRIGHT NOTICE
CANMeds competencies throughout this manual have been adapted with permission
for our rotation objectives from the CANMeds Program of the Royal College of
Physicians and Surgeons on Canada.
http://www.royalcollege.ca/public/canmeds/whatworks
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SECTION 1
Program Information
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DEFINITION
Diagnostic Radiology is a branch of medical practice concerned with the use of imaging techniques
in the study, diagnosis and treatment of disease.
GOALS
On completion of the educational program, the graduate physician will be competent to function as
a consultant in Diagnostic Radiology. This requires the physician to have the ability to supervise,
advise on and perform imaging procedures to such a level of competence, and across a broad
range of medical practice, as to function as a consultant to referring family physicians and
specialists.
Communication skills, knowledge, and technical skills are the three pillars on which a radiological
career is built, and all are dependent on the acquisition of an attitude to the practice of medicine
which recognizes both the need to establish a habit of continuous learning and a recognition of the
importance of promoting a team approach to the provision of imaging services. Residents must
demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to
Diagnostic Radiology. In addition, all residents must demonstrate an ability to incorporate gender,
culture and ethnic perspectives in research methodology, data presentation and analysis.
SPECIFIC OBJECTIVES
At the completion of training, the resident will have acquired the following competencies
and will function effectively as a:
General Requirements:
• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
• Demonstrate effective consultation services with respect to patient care, education and legal
opinions
Specific Requirements:
• Understand the nature of formation of all types of radiological images, including physical
and technical aspects, patient positioning, contrast media.
• Knowledge of the theoretical, practical and legal aspects of radiation protection, including
other imaging techniques and their possible harmful effects.
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• Knowledge of human anatomy at all ages, both conventional and multiplanar, with emphasis
on radiological applications.
• Show competence in manual and procedural skills and in diagnostic and interpretive skills.
• Demonstrate the ability to manage the patient independently during a procedure, in close
association with a specialist or other physician who has referred the patient. The radiologist
should know when the patients’ best interests are served by discontinuing a procedure, or
referring the patient to another physician.
• Understand the appropriate follow-up care of patients who have received investigations
and/or interventional therapy.
• These objectives are achieved frequently over the 5 year training. Individual rotation
objectives are listed in SECTION 3.
Communicator
General Requirements:
• Establish appropriate therapeutic relationships with patients/families.
• Listen effectively.
• Obtain the appropriate information during consultation with referring physicians in order to
be able to make recommendations regarding the most appropriate testing and/or
management of patients.
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• Discuss appropriate information with patients/families and the health care team, and be able
to obtain informed consent for tests and procedures when this is needed.
Specific Requirements:
• Have the ability to produce a radiologic report which will describe the imaging findings, most
likely differential diagnoses, and, when indicated, recommend further testing and/or
management.
• Communicate effectively with patients and their families and have a compassionate interest
in them.
• Recognize the physical and psychological needs of the patient and their families undergoing
radiological investigations and/or treatment, including the needs of culture, race and gender.
Collaborator
General Requirements:
• Consult effectively with other physicians and health care professionals.
Specific Requirements:
• Have the ability to function as a member of a multi-disciplinary health care team in the
optimal practice of radiology.
• The skills of being a collaborator are developed on a day to day basis. Residents are
strongly encouraged to interact with house staff and referring physicians as “first contact” in
order to better develop these skills. In addition, residents will be required to be active
participants in inter and intra discipline rounds.
Manager
General Requirements:
• Utilize resources effectively to balance patient care, learning needs, and other activities.
• Utilize information technology to optimize patient care, life-long learning and other activities.
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Specific Requirements:
• Be competent in conducting or supervising quality assurance including an understanding of
safety issues and economic considerations.
• These skills are learned on a day to day basis as well as through lectures. These lectures
are given by the Department Manager and will teach residents how to run a department in
terms of issues of equipment and staffing. In addition, residents will be exposed to
situations when equipment is purchased for the department and through this will learn the
basics of equipment purchase and tendering. The role of chief resident is another
opportunity to develop managerial skills.
Health Advocate
General Requirements:
• Identify the important determinants of health affecting patients.
Specific Requirements:
• Understand and communicate the benefits and risks of radiological investigation and
treatment including population screening.
• These skills are learned on a day to day basis and are incorporated as in the objectives of
medical experts/decision maker. In addition, community involvement of residents will be
encouraged including community education and charity projects.
Scholar
General Requirements:
• Develop, implement and monitor a personal continuing education strategy.
• The ability to conduct a radiology research project, which may include quality assurance.
• Appreciation of the important role that basic and clinical research plays in the critical
analysis of current scientific developments related to radiology.
• The skills of being a medical scholar are learned on a day to day basis under the umbrella of
a long term plan. For a resident, this would include seeing as many cases as possible
during the days with follow-up reading performed at night. It is recommended that a junior
resident be reading at least two hours a night whereas a senior resident should be planning
to read approximate four to six hours per night. It is very important not to fall behind and to
understand the personal commitment to radiology and the personal responsibility. Critical
appraisal skills will be enhanced through Journal Club but these skills should not, of course,
be limited to this. Residents also participate in the TIPS workshop. Residents will be
required to present and teach to other residents, medical students and house staff. In
addition residents will be introduced to the MCOMP format through rounds which are
accredited and therefore upon graduation will be able to maintain a recording of their
scholarly activities using the MCOMP format (which is necessary for fellowship of the Royal
College).
Professional
General Requirements:
• Deliver highest quality care with integrity, honesty and compassion.
• Practice medicine ethically consistent with the obligations of a physician respecting the
needs of culture, race and gender.
Specific Requirements:
• Be able to accurately assess one’s own performance, strengths and weaknesses.
• The skills of being a medical professional were first introduced in medical school and are
carried through the residency program and beyond. These qualities are developed through
day to day activities on a continuing basis and hopefully enhanced through role models.
The foregoing represents the general and specific objectives that all candidates for the Royal
College examinations in Diagnostic Radiology are expected to meet. For those training in Canadian
programs, these objectives will be accomplished in a staged manner. Residents in Canadian
programs may obtain the document describing this approach from their program directors.
The Diagnostic Radiology Residency Training Committee meets approximately every three months
throughout the academic year. All major decisions, complaints, and concerns should be voiced
and discussed at this meeting. The residents are strongly encouraged to present the residents’
concerns formally at this meeting. Individual residents should bring their concerns to the
Administrative Resident and/or to other residents that may be on the Committee. As well, initial
discussion should take place at each hospital site with the Residency Coordinator. The Program
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Director is always available as well.
To develop a clear program plan, including objectives relating to knowledge, skills, and attitudes and based
upon the general objectives of training in the specialty as published in the specialty training requirements of
the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada,
which plan should also indicate the methods by which the objectives are to be achieved and the role played
by each rotation and by each participating institution;
To select candidates for admission to the program, in accordance with policies determined by the faculty
postgraduate medical education committee;
To conduct the program, including the rotation of residents to ensure that each resident is advancing and
gaining in experience and responsibility in accordance with the educational plan;
To establish mechanisms to provide career planning and counseling for residents and to deal with problems
such as those related to psychological stress;
To assess performance of each resident through a well organized program of in-training evaluation which
will include the final evaluation at the end of the program as required by the College;
To maintain an appeal mechanism through which the residency program committee should receive and
review appeals from residents and, where appropriate, refer the matter to the faculty Postgraduate Medical
Studies Committee.
Such other responsibilities which may be considered specific to the individual program.
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OVERVIEW OF ROUNDS AND TEACHING
Rounds are held daily and offer residents an exposure to radiology and related teaching topics in
didactic and case based format. Rounds are attended by staff radiologists and in most cases led by
that person. There are opportunities for residents to develop teaching and presentation skills
through “subspeciality” and “resident grand round” sessions. Residents are taught the essentials of
radiology case discussion including the presentation of case material and the approach to
evaluating this material. Cased based teaching offers residents an opportunity to develop
consultative skills necessary to practice radiology and prepare for the Royal College examinations.
MONDAYS
ELIVE All residents freed from clinical duties for this time slot
Residents present cases in Power Point format around a topic
selected by them and the participating staff radiologist.
TUESDAYS:
12:00 – 1:00 pm INTERESTING CASE ROUNDS (ICR) at each hospital for staff
and residents at that location (time may vary from institution to
institution):
Residents attend the rounds at the site that they are rotating
through (Janeway resident may attend General Hospital rounds).
Residents and/or staff radiologists will present cases to the
residents in attendance. The resident presented with the case will
offer a description of the images provided, provide a differential
diagnosis and offer further management suggestions. Staff
present for rounds will ensure this is done in a concise and
efficient manner offering assistance and feedback as necessary
to complete the case. It is the goal that each resident in
attendance be shown a case.
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Residents are divided into junior and senior groups and each group is
assigned a location and staff person. Teaching material is prepared
and presented by staff radiologists. Topics are selected to cover topics
from the radiology curriculum. This will usually take the form of a
didactic lecture component. The lecture will often contain case based
examples to demonstrate the topic teaching points. Cases presented
by staff are routinely taken by individual residents in a format similar to
the ICR rounds outlined above.
THURSDAYS:
12:00 – 1:00 pm Staff Subspecialty rounds at Health Sciences Centre or St. Clare’s
Mercy Hospital. ALL RESIDENTS ATTEND.
4-5 pm (JW days)
These rounds are topic based as are the Monday subspecialty
ELIVE rounds. The difference is that all teaching material and cases are
prepared and presented by a staff radiologist scheduled.
These rounds will often reflect a topic in a core area of radiology.
It may also be an opportunity for residents to be exposed to
subspecialty interests of the staff radiologist.
FRIDAYS:
RESPONSIBILITIES OF RESIDENTS:
1) If you cannot present case/topic material on your assigned time you must arrange a
switch with someone else. You must then inform Margie/Jennifer so that an email can
be sent to inform everyone of the change.
2) Rounds must be discussed with assigned staff several days before rounds are
presented.
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JOURNAL CLUB:
Journal Club is an opportunity for residents to practice critical appraisal techniques as they pertain
directly to radiology. Journal Club is held approximately every four weeks and, generally, two
papers are discussed during a session. Staff radiologists with specialty interest in the field covered
by the paper are asked to attend sessions. Papers and topics are chosen by residents in
consultation with a staff radiologist. These papers must offer some educational value to residents.
The paper must be amenable to critical appraisal. Typically such papers tend to be found in
scientific journals such as The American Journal of Radiology or Canadian Journal of Radiology for
example. Articles of a review nature typically do not lend themselves to critical appraisal unless
they consist of a meta-analysis in which case they may be more complex. While such review
articles are of great interest in the practice of radiology they are better reserved for presentation in
the context of other rounds/conferences.
A course in Critical Appraisal and Research Methodology is held each year. This is coordinated
through the Department of Medicine and involves other faculty from Clinical Epidemiology. This
takes place during Winter/Spring of each academic year.
PHYSICS COURSE:
An “in-house” Physics course is currently organized and run by Dr. Edward Kendall. Physics
teaching scheduled for the last Tuesday of every month at 12:00 noon. A more intensive physics
exposure is provided in the “Physics Boot Camp” annually. This is usually held in late summer or
early fall and offers an introduction to new residents and a review for more senior residents. Dr.
Kendall is very approachable and offers his time to senior residents preparing for their American
Board exams. He will typically hold a question and answer session with residents.
A Departmental Management Course is presently being initiated. Details regarding this course,
which will be run in conjunction with the Technical Director, Department of Diagnostic Imaging,
Health Sciences Centre, will be forthcoming.
Each year, 2 – 3 visiting professors spend 2-3 days each with residents providing small group
teaching sessions and mock oral examinations. Guest professors are invited to speak to staff in
addition to holding teaching sessions with residents. This offers an invaluable opportunity for
residents to learn a fresh perspective from a range of excellent radiologists practicing throughout
North America.
ETHICS TRAINING:
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As per Royal College requirements, Ethics training is a part of our radiology residency program.
This will involve teaching, videotapes, care-based discussion, and review of journal articles. Dr.
Fern Brunger and Dr. Christopher Kaposy, Memorial University Ethicists, are available to speak
with residents and are involved in ongoing ethics teaching. There are approximately four sessions
per year. This will be in addition to day-to-day discussion. Also, please refer to the Royal College
Policy regarding “Physicians and Industry – Conflicts of Interest”. Ethics has an online course for
HIC in PGY1 year.
COMMUNICATIONS TRAINING:
A didactic presentation of reporting will be made early each academic year. Reporting formats will
be reviewed along with discussion of legal obligations. This will be in addition to day to day review
of resident reports. Please see below guidelines. Further, residents receive ongoing training as
they review cases with staff radiologists and dictate their findings. Staff radiologists review all
resident reports and will offer feedback as necessary. Feedback early in training is strongly
encouraged to help guide residents in proper reporting technique.
This lecture series has become popular with residents of all levels of training. It is a lecture based
series that began informally to assist new residents in development of an academic base for
radiology training. It attempts to guide residents through the core chapters of a major radiology text,
“Fundamentals of Diagnostic Radiology”, By Brandt and Helms. All residents entering our program
are presented with a complimentary copy of this text book at orientation. While a great introduction
to new residents it serves as a refresher for more senior residents that wish to attend.
ETIQUETTE
Attendance at rounds and lectures is mandatory for radiology residents to ensure maximal
exposure to curriculum. Attendance records are kept.
Be punctual! Residents have priority to attend departmental rounds and teaching. It is the staff
radiologist’s responsibility to cover radiology services during this period.
Speakers spend time preparing for lectures and rounds and will not be encouraged to improve their
teaching material if attendance is low. Participate and be enthusiastic. Resident’s will select a staff
person annually who has provided the most educational value. This staff will receive a teaching
award at an annual social event.
Contribute to rounds! This will benefit fellow residents presented with the case and benefit your
learning through case preparation. Collect cases during your rotation. Cases are to be prepared in
Power Point format with a brief summary of findings and discussion of the main learning points.
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Radiology Residents at Memorial University share call duties with staff radiologists. There is a
graded system of increasing responsibility on call. The frequency of call varies over the course of
residency training but has not been > 1 in 7 recently. Call in our program is categorized as “home
call” and not “in house”. The responsibility for creating the resident call schedule falls with the chief
resident. This is a fair process and includes the input of all residents where possible.
Junior residents entering the program at the PGY2 level initially have no independent call duties.
Exposure to call is structured to allow residents time to obtain the necessary radiology skills to
function in a first call capacity. All PGY2 residents will rotate through ultrasound, emergency, body
CT, Neuro CT blocks before any first call duties are assigned. During this learning period residents
at the PGY2 level will shadow senior residents on call (3 months). This will give residents an
opportunity to watch and learn as senior residents field pages, consult with clinicians, communicate
with radiology technologists, oversee imaging studies, review these studies and report to the
ordering physician. This low stress experience is extremely valuable.
Following a “shadow call “period the resident will begin a “buddy call” phase (4 months). For a
period of 2 months the PGY2 resident will carry the on call pager and report directly to a senior
resident who reviews all studies with the junior resident in hospital. During the next 2 months the
junior has backup from the senior who will assist as needed. Junior residents are strongly
encouraged to seek assistance if there are any concerns.
During the initial months on service PGY2 residents attend lectures by staff on emergency-related
topics. In the late fall the PGY2 resident will be evaluated with an emergency OSCE examination
covering many areas within radiology. Upon successful completion of this exam (PASS mark 70%)
and following successful completion of core radiology rotations the resident will be ready to begin
first call duties with staff backup. While the resident begins first call duties there is staff assistance.
Residents at all levels of training are encouraged to seek the assistance of staff when concerns or
problems arise. Staff are very approachable and readily available on call! Staff radiologists are
committed to a process of graded responsibility and to resident education 24 hours a day.
Summary of graded call responsibilities:
3 months shadow call
2 months buddy (senior in house reviewing all studies with the junior resident)
2 months buddy (senior home call and reviews studies as needed)
After this period the resident is on call with staff backup.
Residents engaged in on-call duties are expected to review imaging studies in a timely fashion and
to provide a report of the findings to the ordering physician. This report must be issued verbally to
the ordering physician and/or physician responsible for care of the patient in question. A typed
report of major findings must also be completed and accompany the imaging study on the PACs
system for review by consultants involved in the case. Post call duties include review of cases done
on call with the staff radiologist on call and the dictation of a completed radiology report using the
Speech Q voice dictation system.
Residents are encouraged to participate in teaching post call when they have not been called into
the hospital to evaluate a patient after midnight.
Communication is a critical component of the art and science of medicine and is especially
important in Diagnostic Radiology. Diagnostic Radiology is one of the most important consultative
services in medicine. This standard has been largely based on the ACR guidelines, which we
acknowledge.
The final product of any consultation is the submission of a report on the results of the consultation.
In addition, the diagnostic radiologist and the referring physician have many opportunities to
communicate directly with each other during the course of a patient’s case management. Such
communication should be encouraged because it leads to more effective and appropriate utilization
of Diagnostic Radiology in addressing clinical problems and focuses attention on such concerns as
radiation exposure, appropriate imaging studies, clinical efficacy, and cost-effective examinations.
In order to afford optimal care to the patient and enhance the cost effectiveness of each diagnostic
examination, radiological consultations ought to be provided and radiographs interpreted within a
known clinical setting. The CAR supports radiologists who insist on clinical data with each
consultation request. This standard is based on the Communications Standard of the American
College of Radiology.
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(a) Each examination should contain a “conclusion” section unless the study is being
compared with other recent studies, and no changes have occurred during the
interval, or the body of the report is brief.
(d) Recommend, only when appropriate, follow-up and additional diagnostic radiologic
studies to clarify or confirm the impression.
B. Written Communication
2. The final report should be proofread carefully to avoid typographical errors, deleted
words, and confusing or conflicting statements, and signed (authenticated) by a
radiologist, whenever possible.
Comment: Electronic or rubber-stamp signature devices, instead of a written signature,
are acceptable if access to them is secure. The signature of the radiologist who dictated
the report should appear on the report. If this is not possible, the initials or name of the
radiologist who dictated the report as well as the initials or name of the radiologist who
signed it should appear on the report.
3. A copy of the final report should accompany the exchange of relevant radiographic
examinations from one health professional to another health professional.
C. Direct Communication
(a) The probable detection of conditions carrying the risk of acute morbidity and/or
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mortality which may require immediate case management decisions.
(b) The probable detection of disease with non-acute morbidity or mortality sufficiently
serious that it may require prompt notification of the patient, clinical evaluation, or
initiation of treatment.
4. Any discrepancy between an emergency or preliminary report and the final written report
should be promptly reconciled by direct communication to the referring physician or
his/her representative.
SUPERVISION OF RESIDENTS
The supervising radiologist has a dual professional responsibility to provide appropriate patient
care and to provide education for trainees. There must be a careful assessment of the
responsibility delegated to the trainee. The resident has a dual responsibility to ensure patients
(and their families) for whom they are providing care know they are on a teaching unit and to keep
attending and consulting physicians informed about their patients.
1. Review the examinations and procedures with the resident in a timely manner. This
includes:
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2. Be accessible (ex. available by pager or phone at all times).
RESIDENT RESPONSIBILITIES
1. Identify oneself as a resident and inform patient (or family) that they are on a teaching unit
and that patient care is a team approach under the supervision of the attending physician.
3. Notify the attending or consulting physician of any abnormal imaging results that may need
urgent management or may significantly affect current patient management.
4. Record in writing on the patient’s report the notification of the attending or consulting physician.
PROGRAM OUTLINE
BY NUMBER OF MONTHS PER YEAR (1 MONTH = 4 WEEKS)
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FOLLOWING 2010 THE NEW ROYAL COLLEGE REQUIREMENTS WILL BE APPLIED.
PGY2:
13 months
2nd YEAR:
3rd YEAR
13 months
4th YEAR
1 month Ultrasound
1 month Body Imaging
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2 months Neuroradiology
1 month MRI/body
1 month OBS
1 month Chest Radiology
1 month Musculoskeletal Radiology
1 month Elective
1 month Selective
1 month Mammography
1 month Pediatrics
1 month Nuclear Medicine
13 months
GI 1 0 0 0 1
1
Chest / CVS/CardioThor 2 2 1 6
(Card/Thor)
Musculoskeletal* 2 1 1 2 6
AFIP 0 0 1 0 1
Nuclear Medicine** 0 2 0 1 3
Angio / Interventional 0 3 0 0 3
Ultrasound 2 1 1 1 5
Mammography*** 0 1 2 1 4
Pediatrics 1 0 2 1 4
Emergency 1 0 0 0 1
Obstetrics 0 0 1 1 2
Rural 0 0 1 0 1
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* ER/NUCS/Body rotations includes some MSK
**Residents wishing to write the American Board examinations must do additional elective
time in Nuclear Medicine.
PGY1 ROTATIONS
DIAGNOSTIC IMAGING
MEMORIAL UNIVERSITY OF NEWFOUNDLAND
PGY-1 house-staff are encouraged to attend rounds, including Journal Club, if attendance does not
interfere with their clinical duties. Residents in PGY1 year have half day teaching on Fridays and
are encouraged to attend any rounds held at that time in the radiology department. The
Fundamentals of Radiology lecture series is a great introduction to residents entering the radiology
program.
During PGY1, residents are informed of this site through the Postgraduate Office. This information
is also on One45 and is linked to each of the individual rotations.
In addition, PGY1 Diagnostic Imaging residents are encouraged to attend rounds in Diagnostic
Imaging especially Friday Rounds and all Physics teaching. PGY1 residents should complete the
on line ethics course (www.pre.ethics.gc.ca/english/tutorial/) during this period.
RESIDENT EVALUATIONS:
Background:
Evaluation is an essential part of our Residency Program. It is meant to be a process of continuous
communication. Evaluations from residents are an important reference for program improvement.
Process of Evaluation:
1. At the beginning of a rotation, you must discuss rotation objectives with your preceptor(s).
2. At the end of the rotation, a summative evaluation should be completed and discussed and the
electronic form validated by you.
What is WebEvaluation?
WebEval is an online web evaluation system. It was created by One45 Software for both undergraduate
and postgraduate university programs.
If you notice any errors in your personal information or have any trouble accessing the site please contact
the administrator Ms. Margie Chafe, at mchafe@mun.ca or 777-7165.
http://www.one45.com/help/postgradAdmin/eDossres.html
The goal of our residency training program is to ensure that our residents receive the best possible
training to master the knowledge, skills and attitudes required of our specialty. A number of
evaluation tools will be used to provide feedback, and to judge and measure performance.
Detailed and timely feedback allows a trainee’s program to be enhanced in any area of weakness.
If problems occur, the resident can be informed early and can be provided with adequate
opportunity for remedial assistance.
This document identifies the evaluation system and guidelines for our Department. It was last
reviewed by the RTC in June, 2010.
EVALUATION TOOLS
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ITEM MINIMUM PERFORMANCE STANDARD
4. Bi-annual Oral Exam 70% overall – scored for each level, based on
Rarely do residents fall below the minimum performance standards of the Department, but if this
should occur, the resident, the faculty and the Department members responsible for the training
program need to understand the program which will be structured for the resident.
In general, if a resident’s weakness is focused then the resident will be assigned extra assistance
by the rotation supervisor. If there is a more general or significant problem documented, a more
structured program of Departmental assistance will be assigned under the supervision of the
Program Director. Continued difficulties which necessitate a change in the usual program of
resident rotations will generally require a more formal program of remediation which will be
structured and monitored under guidelines of the post graduate department of the Faculty of
Medicine and residency training committee. This may lead to interruption in the normal promotion
through residency.
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1. ETHICS AND CONDUCT: A resident can be recommended for dismissal by the Program
Director, subject to approval by the Resident Training Committee if he/she is found to have
violated the University Codes of Ethical Behavior, the Code of Ethics of The College of
Physicians and Surgeons of Newfoundland and Labrador, or the Code of Ethics of the
Canadian Medical Association. A resident can be recommended by the Program Director for
suspension for improper conduct, pending a hearing and formal review, if the conduct is
such that the continued presence of the resident in the clinical setting would be potentially
hazardous to persons or to the academic function of the training program. Faculty of
Medicine guidelines will be followed in all such matters.
2. Research: Each resident will design, conduct and complete a research project or
departmental audit supervised by a qualified individual, usually a staff radiologist, other staff
physician or a basic scientist (Ph.D.) approved by the Residency Program Director. This
project is to be presented at the NLAR (Newfoundland and Labrador Association of
Radiologists conference) or a relevant conference approved by the Program Director.
Each resident will complete a second such project or get permission to expand on an
existing project for the purposes of publication or presentation at a relevant meeting or
conference. An acceptable alternative to completing a second project will be the completion
of a presentation, consisting of a short review of a radiology topic, for the NLAR
(Newfoundland and Labrador Association of Radiologists conference).
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c) receives a grade on the ACR below the minimum standard
OR
d) receives a grade on the Department Oral below the minimum standard
OR
e) receives a grade on the Department OSCE below the minimum standard
The resident will meet with the Program Director to discuss the problem(s). The resident may be
assigned remedial work which could include any combination of assigned reading or academic
review, work with an assigned mentor or repeat exams at the discretion of the Program Director.
This remedial work could extend up to three months and will be evaluated under the direction of the
Program Director.
If within one year of commencing this Departmental remedial work the resident receives a second
evaluation below the minimum performance standard the resident may be recommended for a
more intensive program of remedial assistance.
If within one year of commencing the Departmental remedial work the resident receives a third
evaluation below the minimum performance standard, the resident may be recommended to a
formal program of remediation, or remediation with probation, or probation by the Program Director
with the guidance of the Residency Training Committee. This recommendation will be subject to
review by the Post Graduate Department of Memorial University. The remediation program and
evaluation guidelines will be indicated in writing prior to the start of the program.
If this remediation program is successful, the resident may be recommended for continuation in the
program at the appropriate level. If this program is not successful, the resident will be
recommended for further remediation, remediation with probation or probation. Credit for
remediation rotations may not be given if the goal(s) of the remediation is not attained.
Remediation with probation or probation implies the possibility of refusal for promotion or of
dismissal if the resident is unwilling or unable to meet the required standards of performance. This
is to subject to review by the Post Graduate Department of Memorial University of Newfoundland.
If a resident successfully completes a program of remediation but within the next twelve months
falls below the minimum performance standard on any evaluation, the resident will again be
recommended for a further formal program of remediation, remediation with probation, probation or
dismissal.
PGY5: Failure to meet the minimum performance standard on any ITER overall or other evaluation
item will be grounds for an immediate review of training performance and recommendation for
formal remediation. Failure to meet the minimum performance standard on two evaluations in the
PGY5 year will be grounds for recommending notification to the Royal College that Department
Training Standards were not met and for recommending the resident not proceed to the college
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exams. This will also be grounds for recommending the resident repeat the PGY5 year. This will
be at the discretion of the residency program director and/or residency training committee.
If unusual or extenuating circumstances exist concerning a resident subject to any of the above
items, the Program Director with the approval of the Residency Committee and/or post Graduate
Department can alter the recommendations listed.
Any decision by the Program Director to recommend remediation for, probation for, or dismissal of
a resident must be made in consultation with, and approval by, the Residency Training Committee
of the Department of Diagnostic Imaging. Any decision by the Program Director to recommend
remediation for, probation for, or dismissal of a resident must be made in consultation with, and
approval by, the Residency Training Committee of the Department of Diagnostic Imaging. The
Chair of the Department and Post Graduate Department shall be informed of all decisions.
Any decision to recommend remediation for, probation for, or dismissal of a resident must be
reviewed and approved by the Postgraduate Education Evaluation Board of Memorial University.
Any decision to dismiss must also be approved by the Chair of the Department and by the
Associate Dean, as indicated in University Guidelines.
Any decision by the Board may be appealed by a resident according to the University’s Guidelines
for appeals.
EVALUATION PROCESS
DEPARTMENT OF DIAGNOSTIC IMAGING
1. All trainees should be provided with a copy of the Department Guidelines for Resident
Evaluation at the beginning of their PGY2 Year and at any time these standards are changed.
2. All trainees should be provided with a copy of “Guidelines for Evaluation of Residents of the
Faculty of Medicine of Memorial University”.
3. A resident should receive a copy of and/or provided with verbal details of all evaluation results
or this should be provided on request to the trainee. All such results should as well be kept as
part of the resident’s University file.
4. The Resident Evaluation form (ITER) should be designed and adopted by the Residency
Training Committee. The form must be accompanied by guidelines to assist the supervisor(s) in
marking individual items. Comments should be made on any specific areas of performance,
which contribute significantly to the evaluation, especially in areas of weakness. For the
purpose of completing the form, appropriate medical and non-medical personnel should be
consulted about the resident’s performance. If a problem is identified at any point during a
rotation, the supervisor must bring this to the attention of the resident promptly.
5. At the midpoint of any rotation which is 2 months or longer, the supervisor must provide the
resident a mid-way evaluation.
28
6. At the end of every rotation, an evaluation (ITER) must be completed. The supervisor should
discuss this evaluation with the resident preferably before the end of rotation or as soon
thereafter as possible. Residents should approach rotation supervisors requesting this by the
end of the rotation or shortly thereafter if they are not aware of arrangements to meet staff.
7. The resident will be given a reasonable time to consider and comment on the evaluation.
8. Completed evaluation forms are to be reviewed by the program coordinator within one month of
the end of rotation. This will allow the program coordinator to be aware of and if appropriate,
address problems in the rotation or relating to the residents’ performance in a timely fashion.
Any supervisor providing a “borderline” or “failed” evaluation is required to speak directly to the
program coordinator before the end of rotation. One45 evaluation systems alerts the program
director to Low Performance grades.
9. Completed evaluation forms are to be sent to the administrative office within one month of the
end of rotation. One45 evaluations are automatically forwarded to administration for review
once completed.
11. Results of ACR Exams, Department Exams, the Physics Exam, and completion of the
Research requirement will be sent to and reviewed by the Program Director.
12. A Resident Evaluation Committee, which will be a subcommittee of the Residency Training
Committee, under the leadership of the Program Director, shall be responsible for all matters
pertaining to the Standards, Process, Review and Promotions of the residents.
13. The Resident Evaluation Committee will be appointed annually by the Program Director with
the approval of the Residency Training Committee. Members will include the Program Director,
residency training committee members and one resident representative (preferably a senior
resident).
14. The Resident Evaluation Committee or Residency Training Committee shall meet/communicate
i) once a year to consider and approve all resident promotions for notification of the
Post-Graduate Office.
ii) at any time that the performance of a resident requires consideration of assistance,
remediation or program modification.
15. When a resident’s performance falls below the minimum evaluation standards, the Program
Director shall meet with the resident and review the performance issues. The Program Director
may call a meeting of the Resident Evaluation Committee to discuss a program of remedial
assistance which will be outlined to the resident. A report on this program shall be presented to
the Residency Training Committee at the next regularly scheduled meeting and/or discussed
with individual committee members when no meeting is pending.
16. Any recommendation for formal remediation under the University guidelines shall first be
considered by the Resident Evaluation Committee, but shall then be presented to and approved
29
by the Residency Training Committee. The Chair of the Department shall be informed of all
decisions.
17. The notification, approval and process of Remediation shall follow the Guidelines outlined by
the University.
Conflict Resolution and Appeals
If a resident has a concern he/she should address it at earliest convenience according to the
following process:
Staff member +/- chief resident support
Site Coordinator
Training Committee
Chair
Postgraduate Dean
Dean
University Senate
The Program Director can be approached directly as deemed appropriate by the resident.
30
APPEAL PROCEDURE FOR AN UNSATISFACTORY EVALUATION
In the training of Radiologists the Memorial University Radiology Residency Program aims to
provide an educational program which will be adequate to meet the trainee’s educational and
professional needs. We strive to evaluate the trainees to ensure that they have successfully
acquired the required knowledge, skills, attitudes, behaviors and ethical standards to practice
competently.
While regrettable, there may be the occasional trainee whose academic performance or
professional behavior is unsatisfactory requiring that the resident’s program be extended or that the
training be terminated. It is essential that the evaluation systems be valid and appeal mechanisms
fair. Residents may appeal an evaluation through their Residency Training Committee. Residents
should be aware that an appeal process may or may not support their case.
Where applicable, residents are urged to first discuss an evaluation or concern with the rotation
supervisor.
The resident then may appeal first to the Program Director in order that the appeal can be reviewed
by the Residency Training Committee. This can be done by the resident alone, the resident
accompanied by the chief resident or staff radiologist of the resident’s choosing. The Residency
Training Committee will convene in a reasonable time not to exceed 2 weeks.
If the resident is unsatisfied with the findings and decision of Residency Training
Committee, an appeal can be made to the Associate Dean, Post Graduate Medical Education, for
the appeal to be heard by the Post Graduate Medical Education Committee. The decision reached
by the PGME Committee will be forwarded to the Program Director. After an appeal to the PGME
Committee the trainee can appeal to the Student Appeal Committee of the Faculty of Medicine,
Memorial University of Newfoundland.
If the initial discussion with the supervising faculty and Program Director did not result in
satisfactory resolution of a grievance, the resident may initiate an appeal by submitting a written
letter to the Program Director within one month of the original evaluation. The written appeal will be
brought to the Residency Training Committee at a specially scheduled meeting. Two residents
must be in attendance.
The Program Director or designate will provide a brief introduction for the appeal. A designate will
act on behalf of the Program Director when it is the Program Director’s decision that is being
appealed. In this case, the Program Director will act as a nonvoting committee member. The
31
Program Director or designate will summarize the reasons for the initial evaluation. Following this,
the resident may present his or her case to the RTC or may have an advocate speak on the
resident’s behalf (the RTC must receive advanced notice if a resident will have an advocate at the
meeting). Following discussion, the resident, resident advocate and Program Director (if a
designate is present) will leave the room while remaining committee members discuss the issues
and vote by a closed ballot. The result of the vote will constitute the final decision of the RTC. A tie
vote will be decided in favor of the resident. The outcome will be discussed with the resident in
person as soon as possible. A written statement of the outcome will be sent to the resident,
Departmental Chair and Post Graduate Dean.
A resident who is not satisfied with the departmental appeal can appeal to the Post Graduate
Medical Education Committee through the Associate Dean. Appeals must be submitted in writing
within 10 days of receiving the results of the departmental appeal. The appeal at the Post Graduate
Medical Education Committee will be limited to an assessment of the "justness" of the decision and
whether the process followed at the departmental level supported the decision reached.
The Faculty of Medicine Ombudsperson is Dr. Stephen Lee, a local family physician. His role is that
of a “third person” who can step in if a student has concerns with a program or department head
and feels they can’t deal directly with the concern. The role is not to provide counseling or to
investigate, but to help students identify pathways to take their concerns for answers or action. Dr.
Lee can be reached at ombudsperson@med.mun.ca.
32
RESIDENT RESEARCH
DEPARTMENT OF DIAGNOSTIC IMAGING
Requirements and Resources
(August 2010)
Requirement:
A. At least one completed research project during residency.
B. A second completed research project OR a short presentation reviewing a topic in or
related to radiology to be presented at the NLAR meeting.
• Case Reports
• Letters to Editors
• Case of the Month
• Review type exhibits
Definition of completion
• Presentation at the NLAR Research Day (held annually) and/or presentation at national
or international meeting
• Formal written submission for publication to a Medical Journal (Follow guidelines for a
uniform requirement for manuscripts submitted to Bio-Medical Journals --Annals of
Internal Medicine 1988; 108.258-265.)
Time
Over the final four years of residency (PGY 2-5) each resident will have an appropriate amount of
time allocated for the completion of a research project. If time is to be taken from clinical rotations
an appropriate leave form must be filled out and submitted to both the residency training director as
33
well as the Clinical Chief for the division in question. This should not exceed 1 day per week in any
clinical rotation or a maximum of 20 days in total not including the July and August ½ day time
period.
Residents are encouraged to use summer ½ day assignments to complete research projects as no
formal teaching schedule is in place at that time.
Residents may also apply to do research electives during their PGY training.
Mentors
All research should be performed in conjunction with a staff person mentor. That person can either
be an active participant in the research project or may simply be available for guidance.
That staff person will be responsible for ensuring the quality and completion of the project and
therefore must be identified when the research project is identified to the University office.
All office administrative staff are available for material services related to research projects.
Dr. Kendall’s research assistant will also provide assistance with HIC proposals and material
arrangements. She can be reached through the Office of the Chair.
Services provided to residents:
- type/assist with completion of proposal/consent for Human Investigation Committee
- type/assist with completion of research grant applications, if any
- type/submit manuscripts and abstracts
Dr. Angus Hartery, Program Director
Dr. Benvon Cramer, Professor and Chair, Diagnostic Radiology Academic Program
All research even if not completed must be documented with the University Radiology
offices.
At the onset of any radiology research project a short description of the project must be
submitted to the Office of the Chair giving details about the project and the staff person that
has agreed to participate in the project. This is used in record keeping.
The Office can also enable coordination of any applications for research funding.
34
FINANCIAL SUPPORT FOR RADIOLOGY RESEARCH
The University has limited funding for assisting Residents to either present or publish their research
at organized meetings but will aim to fully cover presentations up to two per year. Application for
the same must be made in advance prior to submission through the Radiology University office.
Applications for funding should be made up front and well in advance of meeting. Residents are
provided with funding to present at authorized conferences or meetings.
All research projects must be passed through the Human Investigation Committee of Memorial
University. All detailed information including applications, frequently asked questions, and
suggestions on how to fill out the application are available on the web site www.med.mun.ca/hic.
Kathy McKay will assist residents in this process.
It is anticipated that most and eventually all radiology residency projects will qualify for expedited
review and typically this can be turned around in less than one week.
All research carries limited financial impact on the hosting institution. Therefore a mechanism has
been developed to identify that impact.
Once full approval has been granted by HIC, research proposals are then reviewed by Research
Proposal Approval Committee (RPAC). The primary mandate of this committee is to review
resource utilization for any project to be conducted within the corporation. Review by RPAC
requires submission of a short form, which provides a brief explanation of the project, associated
costs and sources of funding.
All projects are reviewed and approved by the Program Clinical Chair before receiving final full
approval from RPAC.
- The committee meets monthly
- It will be the responsibility of the investigator initiating the research project to insure
appropriate institutional and departmental approvals are in place prior to undertaking
any research project.
After the project is completed a one page abstract identifying the principal investigators, the design
of the project and the conclusions, if any must be submitted to the Radiology office.
Documentation of all research projects must be provided.
36
GUIDELINES FOR RESIDENT RESEARCH PROJECTS
A Three-Phase Venture:
If funding is required for the study, application must be made to the appropriate agencies.
Appropriate application must be made to HIC as well as the Hospital Funding Committee. A
draft proposal must also be registered with the Radiology office.
2. Study:
3. Presentation:
Either a written paper for submission to a medical journal or a presentation at the NLAR
Annual Scientific Meeting. A one page summary must also be submitted to the Radiology
office. Projects will be funded if presented in North America or at an authorized international
location. Please confirm with Rhonda BEFORE the submission of abstract.
I. Proposal
The research proposal is outlined. It is then to be reviewed by the appropriate staff person.
This should achieve several objectives:
a) learn the correct way to design a small project
b) help the resident design an achievable goal
c) documentation must be provided to the radiology office so that possible conflicts or
repeating research projects can be avoided.
d) after completing these steps the appropriate applications to the HIC as well as
hospital funding committees must be made.
37
II. Study - Considerations for Designing a Research Project
1) What is your question? Be specific. (There may be more than one - be very precise in
describing what they are. This is the most important part.)
Do a literature search and read the papers. Has this been done by others? What can
you learn from their work?
2) What do you expect to find? What other possible answers could there be?
a) Why is it important to answer this question? What effect will your answer have?
Does it have any clinical (practical) implication?
Pilot Studies
Comparison of Technique - i.e. Two types of films, two filters, two methods of
labeling, etc. (may not need gold standard)
- make sure you answer enough questions to decide if patients have met your “gold
standard” criteria!
- make notes on why you made a particular decision! (You will forget).
- design a data chart and do a “pilot” to check you have enough information
III) Decide on a time frame! Is this realistic? Who will need to help you get this done?
Are they willing to help? Does this need money?
IV) What problems and limitations do you anticipate? How can you get around this?
39
f) Analysis. How do you expect to analyze your results?
g) Anticipated problems and limitations
Completion of Project:
- Paper Submitted in written format to the Radiology office. The paper should be written up
following guidelines in “Uniform Requirements for Manuscripts Submitted to Bio-Medical
Journals”, Ann Intern Med 1988; 108: 258-265. It is encouraged that residents submit their
manuscripts for publication. If the manuscript has been published, a copy of the published
article may be submitted to the Research Committee.
Method: Basically this is your proposal - written in past tense as opposed to future
tense. For example: Who or what did you study? How did you do it and
What did you do with the information when you got it?
Results: Present in clear fashion with appropriate use of tables, figures, point out
important trends and findings.
What is the significance of your results? If they disagree with others - why?
Sum things up in one paragraph at the end.
40
RESIDENT TRAVEL
FUNDING GUIDELINES
1) Reimbursement for all resident travel must first be approved by the Professor and Chair. If you are
planning to submit a paper for presentation, please discuss funding with the Chair beforehand.
2) If residents are presenting a paper at a Radiology conference in North America, their travel expenses
will be paid up to $3000.00, but please remember that the funding needs to be approved before
submission of your abstract/poster
.
3) Residents are expected to avail of the most economical fares for conference, airfare and ground
transportation to and from the conference site. Memorial University does not reimburse for rental
cars unless they are the most economical means of transportation and rental of vehicles need to
have prior approval before travel.
4) When residents wish to attend a conference where they are not presenting a paper, they can be
funded $750.00 towards their travel, but this must also be approved before travel plans are made.
This amount is currently under review and may be increased.
5) Residents are funded to attend the Newfoundland and Labrador Association of Radiologists (NLAR)
Annual Scientific Meeting held in Corner Brook each year by the Discipline or the NLAR.
6) To clarify the above, a resident will receive money for EITHER Item #2 or #4 above, but not both.
7) Third year residents receive $5500.00 in funding towards their travel costs to the Armed Forces
Institute of Pathology course, and their registration fees of $1600US are paid in advance for them.
8) Rural Rotation Travel. Residents who travel to Corner Brook for their rural rotation will be covered by
the Postgraduate Medical Education Office. When travelling to the Rural Rotation in Corner Brook,
either gas up in St. Johns and along the way, if needed OR gas up along the way and then once you
arrive in Corner Brook that same day. Receipts are mandatory for reimbursement and meals.
Receipts need to be submitted to the Postgraduate Office. Accommodations are paid for by Western
Health providing residents avail of their accommodations.
9) Senior residents receive $1,250 towards travel to a Radiology Review Course in their final year.
IMPORTANT POINTS
1) A Travel Request form must be completed before travel commences (obtain form from Rhonda)
2) Travel Claims must be completed within 10 days of the end of travel. All receipts for expenses must
be retained and submitted. This includes the official airline itinerary with cost, boarding
passes, hotel receipts, taxi/shuttle receipts. A brochure from the meeting must also be
submitted with your travel claim.
41
3) Travel Advances are available for residents.
4) If a travel advance is given, receipts must still be kept and a resident still needs to complete a travel
claim within 10 days of the end of travel.
5) Registration fees for meetings can be paid by the University in advance of the meeting so you
will not be out of pocket for this expense. Residents can provide the details to Rhonda and she
can process the registration though the University.
6) Eastern Health Travel Guidelines: Resident must fully complete their travel request form, sign and
date it, and submit it, along with all necessary supporting documentation, to the PGME office. For
residents travelling to New Brunswick, for core rotations, they must seek reimbursement for the first
half of their travel expenses while in New Brunswick.
CONFERENCE LEAVE
SICK LEAVE
• Contract states 2 days/month – cumulative during each contract year. Forms must be
completed and submitted to the academic office upon returning to work.
VACATION TIME
• 4 weeks/year.
• Preferably taken in one-week blocks. No more than one week off per 4 week rotation.
• If vacation has not been arranged for each year, it may be arbitrarily assigned.
• Holiday and conference leave forms must be signed and returned to the Chairperson’s office
at least two weeks prior to any leave; if not, we will not guarantee that payroll will continue
the resident's salary during this time off.
• There must be 2 residents at each site at all times, with the exception of the Janeway site.
42
CRITICAL INCIDENT AND STRESS POLICY
DISCIPLINE OF RADIOLOGY
PURPOSE
To establish authority and process to be followed within the Discipline of Radiology in response to a
Critical Incident or Significant Stressor ultimately assisting residents who are involved directly or
indirectly in patient care situations that involve negative outcomes, either real or perceived or
assisting residents confronted with other significant stressors.
SCOPE
This policy will apply to all residents in the Discipline of Radiology as well as any residents or
medical students who are participating in a radiology elective at the time of a critical incident.
DEFINITIONS
Critical Incident (CI) - An occurrence in which the resident is exposed to a negative patient outcome
over which he or she feels they had a direct or indirect influence. This could include a patient’s
death that they personally witnessed or were involved with, regardless of whether they felt they
acted appropriately or not.
Significant Stressor – Any significant stimulus contributing to a level of undue stress on a radiology
resident that is identified by the resident, staff radiologist or other individual which requires attention
to improve the quality of life, quality of work, academic progress, well being of the resident and/or
patient care.
Program Director – The faculty member responsible for the Radiology Residency Program
Staff Radiologist – Radiologist employed by Eastern Health and engaged in resident education.
A critical incident occurs in which the resident or supervising staff radiologist feels the resident
needs to have a debriefing regarding the event. Either the resident or supervising staff shall be
responsible for identifying the incident to the program director. Examples of CI may include any
adverse outcome during a patient encounter. This would be most relevant to residents on rotations
with procedural components such as interventional radiology.
A significant resident stressor may be identified by the resident him/herself, the program director or
another individual(s).
* The staff person is responsible for referring the resident to the CI/stress process. Referral is made
to the program director by the staff person or resident involved. The referral can also be made by
another health care provider who has knowledge of the event.
* Where possible the referral for CI/stressor must be made within 3 days of the event. In situations
where the effect of the CI/stressor is not immediately obvious, the referral must be made as soon
as possible after the effect becomes obvious. The program director will arrange the meeting.
* The first meeting shall be attended by the program director and the involved resident +/- the
attending staff. The resident may elect to have another staff radiologist or mentor present/involved
if there is a preference. If the resident designates such a staff to assist in the process then the
program director may be excused.
* Further referrals to other experts may be deemed appropriate; the Program Director or
designated staff will be responsible for arranging such meetings with permission of the resident.
* The confidentiality of the meeting is paramount and discussions will not leave the room. The only
documentation shall be that the meeting occurred, who was present, when the next meeting is
scheduled and that all parties are in agreement with what was discussed. This meeting shall not
become part of the resident’s permanent record.
* There must be a follow-up meeting between the program director/other designated staff
radiologist and resident, within 2 weeks to ensure any outstanding issues are resolved and that the
resident is coping with the event. The Program Director or designated staff will arrange this
meeting.
Support Services for Residents Involved in a Critical Incident or facing significant stressors:
The Resident shall be offered or referred for further counselling to one or more of the following
services;
44
* Dr. Scott Moffatt (Postgraduate counselor 553-6216)
* PAIRN, if appropriate
* CMPA, if appropriate
Harassment Policy
A formal policy on Intimidation and Harassment is available through Postgraduate Medical Studies. This
policy also briefly addresses ethics and guidelines of conduct. The web site is:
http://www.med.mun.ca/getdoc/759aa8ce-9b52-4989-bb50-f55c9f4c8a7e/Policy-on-Intimidation-and-
Harassment.aspx
Support is offered by the office of Postgraduate Medical Studies through their Postgraduate Counsellor, Dr.
Scott Moffatt. Dr. Moffatt is available directly or through the Postgraduate Office. This confidential service is
separate in every way from the residents’ evaluations and the discipline’s assessments of the resident.
Issues which arise among residents include the academic stress of residency, career choice issues,
interpersonal conflict, financial stresses, and personal issues as a resident tries to find balance between
their personal life and their life as a resident. The services are confidential and there is full backup support.
In addition the Postgraduate Medical Studies office has had visiting speakers discussing stress
management.
Herein the phrase, “the resident”, refers to any person currently enrolled in post graduate radiology residency
training at Memorial University of Newfoundland or any person not enrolled that is authorized by educational
authorities to rotate through the radiology services of Eastern Health.
1. Safety policies of the Memorial University Radiology program reflect the broader safety policies of the
postgraduate office, Eastern Health and Memorial University of Newfoundland. Please refer to each authority for
current policies. Policies of those authorities supersede points 2 through 5 below.
2. Assessment of safety threats in the day to day performance of tasks performed as a radiology resident is left to
the discretion of the resident.
3. Any work place situation deemed a threat is to be avoided at the discretion of the resident until such a time that
the resident has sufficient support from other staff and/or security to proceed.
4. Campus police and civil police are available at 7280 and 911 respectively and should be notified of significant
security/safety risks at the discretion of the resident.
5. Resident travel encompasses a variety of transportation modes potentially used by the resident through the
course of residency training. It is the responsibility of the resident to ensure that travel, in the context of the
45
residency training requirements, is safe in all respects. All travel choices are at the discretion of the resident.
Residents are encouraged to consult relevant agencies or authorities when traveling or planning to travel for
necessary information to aid in the decision process.
In general clothing must be clean, proper fitting, comfortable and non restrictive. Beach style clothing, crop
tops, halter tops and revealing clothing are not appropriate. Stiletto heels are also not appropriate.
PRINCIPLES:
1. Postgraduate trainees should have options if they are enrolled in a program which they feel is
inappropriate for their needs.
2. No program will be required to accept a postgraduate trainee who does not meet the programs'
admission criteria or for whom adequate training resources are not available.
3. All transfer requests will go through the Postgraduate Medical Studies Office. The PGME Office will
facilitate application while maintaining postgraduate trainee confidentiality.
4. The application and approval process will follow the “Procedures for Transfer”.
5. Potential recipient programs will have access to the trainee's original CaRMS application, in- training
evaluations and academic record; with signed authorization of release by the applicant.
7. In order for programs to have an opportunity to review all potential candidates, the deadline for
completed application will be:
i. October 30 - for January transfer
ii. April 30 - for July transfer
8. All trainees will be advised of this policy at orientation and a copy of the policy will be
contained in the PGY I Handbook.
9. Recognizing the potential stresses related to decisions to transfer, all applicants are
46
encouraged to seek counseling through EAP or the Postgraduate Counselor.
(Candidates may be required to seek this following that interview with the Postgraduate Dean).
10. Candidates with return-in-service agreements must clear potential transfers with their
Sponsoring body.
11. Candidates who have received bursaries must clear potential transfers with the Department
Of Health prior to application deadlines.
12. This transfer process is not intended to subvert the CaRMS match.
13. Candidates are not eligible for transfer prior to their PGY I year.
The following policies can be accessed on the Eastern Health intranet at:
http://intranet.easternhealth.ca/EH/policies.aspx
49
Recommended Reading
The following is a list of books recommended for reading by residents and staff in radiology in many
programs across Canada. This list might be used to form the basis of a library.
Recommendation
A. GENERAL TEXT:
B. CHEST:
3. Chest Radiology:
Felson....................................................................................................Must Read
C. CARDIOLOGY:
50
Interpretation
Miller ………………………………………………………………………..Reference
D. MAMMOGRAPHY:
Breast Imaging:
Kopans ..................................................................................................Must Read
E. PEDIATRICS:
F. GASTROINTESTINAL:
1. Gastrointestinal Radiology:
Gore and Levine ...................................................................................Must Read
G. GENITOURINARY:
51
1. Textbook of Uroradiology:
Dunnick, Reed and McCallum (new edition) ........................................Must Read
H. SKELETAL:
4. Orthopedic Radiology:
Greenspan ............................................................................................Reference Text
I. NEURORADIOLOGY:
2. Diagnostic Neuroradiology:
Osborn...................................................................................................Must Read
52
Som and Bergeron ................................................................................Reference Text
1. Diagnostic Angiography:
Kadir ......................................................................................................Must Read
3. Gastrointestinal Angiography:
Reuter and Redman..............................................................................Reference Text
L. CT and MRI:
M. ULTRASOUND:
1. Diagnostic Ultrasound:
Rumack, Wilson and Charbonneau......................................................Must Read
Cullen ……………………………………………………………………….Reference
53
N. NUCLEAR MEDICINE:
O. PHYSICS:
P. BIOSTATISTICS:
Q. RADIOBIOLOGY:
54
SECTION 2
Aims and Objectives:
PGY I RCPSC Specialty Programs
55
Aims & Objectives: PGY I RCPSC Specialty Programs
http://www.med.mun.ca/getdoc/3fd0a6ce-858b-465b-99a5-b9d102145682/Complete-Aims-and-
Objectives.aspx
INTRODUCTION
A training program must have clear and measurable objectives. These objectives must include both
cognitive and non-cognitive areas and appropriate evaluation is essential. In-training evaluation will be
completed by the designated attending staff in each rotation. The trainee will be responsible for completing
the trainee evaluation of the rotation. The in-training objectives and the trainees' attention to these objectives
become very important as they attempt to achieve the goals we have set. These objectives are intended to
serve as an outline of the essential elements of each rotation. Although not all named conditions may be
seen by every trainee for every rotation, trainees should be familiar with them. In many cases, you may be
able to achieve a much higher level of knowledge than outlined by these minimal objectives.
56
EMERGENCY COMPONENT OF THE PGY I PROGRAM
I. PROGRAM OBJECTIVES
Through the high volume of attending patients the trainee has the opportunity to acquire history and physical
assessment skills, the ability to develop a differential diagnosis and to formulate investigative and treatment
plans under the guidance and direction of the staff emergency physician. The trainee will learn to manage
time and co-ordinate the care of a number of patients simultaneously. Communication skills should improve
by case discussions with the staff emergency physician and consulting services and speaking to concerned
patients and relatives.
The trainee will be expected to participate in the provision of pre-hospital care and must be prepared to
provide both basic and advanced life support in the pre-hospital environment. Radio and telephone
consultation with the emergency physician on duty is readily available.
Knowledge of the appropriate procedures for certification in cases of sudden death and when to request
medico-legal autopsies is expected.
Knowledge:
1. To know the presentation and management of common medical, surgical and traumatic
emergencies.
2. To recognize the indications/contra-indications and complications of emergency invasive and non-
invasive procedures.
3. To know the indications/non-indications for laboratory, imaging (CAT, MRI, nuclear, traditional) and
cardiologic investigations appropriate to the emergency setting.
4. To recognize and assess the medico-social, psychological and legal aspects of acts of human
violence.
Skills:
3. To quickly formulate a working differential diagnosis, focusing initially on those serious conditions
that need prompt confirmation or exclusion.
1. To demonstrate the ability to establish a therapeutic relationship with patients and their families.
4. To demonstrate the ability to deliver information to colleagues and members of the health care team.
COLLABORATOR
1. To know and respect the appropriate roles and skills of members of the health care team.
2. To demonstrate the ability to work effectively within the health care team.
3. To contribute effectively to interdisciplinary team activities.
HEALTH ADVOCATE
MANAGER
PROFESSIONAL
1. To develop good habits of charting, with concise recording of pertinent negative and positive
findings.
2. To exhibit appropriate personal and interpersonal professional behaviours.
3. To develop a greater appreciation of issues of consent, minors and adults, confidentiality and the
roles of outside agencies (police, media, social services, public health) in the emergency setting.
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SCHOLAR
1. The method of evaluation will come from the clinical case presentations and discussions with the
Staff Emergency Physician on a day-to-day basis.
2. Charting - Charts are audited daily and evaluated by the staff emergency physicians.
3. Quality of care rendered to the patients.
4. Nurses'/other Health Professionals’ critique - Because of the interaction of allied professionals with
the trainee and their vast experience, they often have very valuable impressions of the trainees.
5. Patient's input - We often have comments from the patients or their relatives regarding treatment and
attitudes or behaviour of the housestaff.
IV. ORIENTATION
Before starting in the Emergency Department, housestaff must receive orientation from a staff emergency
physician. An orientation meeting takes place in the Emergency Department at 0800 hours on the day that
each rotation commences. The intent of these orientations is to familiarize the housestaff with the structure
and function of the Emergency Department as well as the ambulance service. It is during this session that
the trainees are given the opportunity of having hands-on experience with the Life-Pak 5 (monitor
defibrillator), MAST Trousers, as well as the slit lamp, etc.
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INTERNAL MEDICINE COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
Undergraduate teaching and training do not, by themselves, prepare the student adequately for independent
medical practice. There is a need to continue the teaching and training in internal medicine from the
clerkship program into the PGY I program. During the PGY I year, clinical experience should be offered on a
broader and more advanced level than the one gained during clerkship.
The overall objective of training and teaching is to equip the trainee with the knowledge, skills and attitudes
of internal medicine that would be of help to the non-internist. The program will aim to achieve the following:
1. To expand and consolidate the knowledge and clinical skills and abilities gained during clinical
clerkship.
2. To provide clinical experience in:
i. ambulatory care,
ii. emergency care,
iii. in-hospital and continuing care.
3. To provide trainees with sufficient knowledge and skills to be confident in the detection and
management, at a primary care level, of the most frequent forms of illness encountered in internal
medicine. They should also provide the knowledge that would enable appropriate specialist
consultation.
Knowledge:
1. To demonstrate knowledge of the common symptom complexes, acute illnesses and medical
emergencies as they present in various settings (ambulatory care setting, hospital). Including but not
limited to:
i. myocardial infarction
ii. angina
iii. congestive heart failure
iv. bronchial asthma, exacerbation of chronic obstructive lung disease
v. cardiac arrhythmias and cardiac arrest
vi. cerebrovascular accidents
vii. drug overdose and poisoning
viii. DVT/pulmonary embolism
ix. gastro-intestinal bleeding/peptic ulcer disease
x. diabetes/hypoglycemia
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xi. hypertension
xii. common infections such as pneumonia, cystitis and pyonephritis
xiii. altered level of consciousness
xiv. acid base, fluid and electrolyte balance
xv. anemias
xvi. jaundice
xvii. obesity
xviii. seizure disorders
xix. degenerative and rheumatoid arthritis
xx. Parkinson's disease
xxi. tuberculosis
xxii. bleeding disorders
xxiii. sexually transmitted diseases
xxiv. myxedema and thyrotoxicosis
xxv. peripheral vascular disease
xxvi. gout
xxvii. dementia
xxviii. acute and chronic renal failure
xxix. aging and its influence on presentation, diagnosis and management
xxx. headache
xxxi. common peripheral nerve disorders
2. To demonstrate the ability to recognize the principles of management and recognition of other
medical problems including various leukemias, lymphoma, multiple myeloma, AIDS and various
carcinomas.
Skills:
1. To perform an appropriate history and physical examination, recognizing significant positive and
negative physical signs.
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COMMUNICATOR
1. To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2. To demonstrate the ability to perform an effectively focused history.
3. To demonstrate the ability to effectively deliver/receive information back to/from patients and
families.
4. To demonstrate the ability to effectively deliver/receive information to/from colleagues and members
of the health care team.
COLLABORATOR
1. To know and respect the appropriate roles and skills of member of the health care team.
2. To demonstrate the ability to work effectively within the health care team.
3. To be conscious of the needs of others including fellow staff members and patients.
HEALTH ADVOCATE
1. To demonstrate knowledge of home and community support services for the chronically ill.
MANAGER
1. To understand the impact of the cost of treatment.
2. To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3. To be attentive to preventative measures.
PROFESSIONAL
1. To recognize and deal with one's own anxieties, limitations and personal prejudices.
2. To demonstrate a sense of responsibility.
3. To demonstrate accurate self-assessment skills (e.g. insight).
SCHOLAR
1. To demonstrate an ability to recognize learning needs.
2. To critically appraise sources of medical information.
3. To actively participate in learning opportunities.
4. To facilitate learning of patients, other housestaff/students and other health professionals.
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IV. CLINICAL TEACHING UNIT EXPERIENCE
The Health Sciences Centre and St. Clare's Mercy Hospital provide general medicine and subspecialty
clinical teaching experience.
In the General Hospital, Health Sciences Centre, there are four general medical services and two
subspecialty services, cardiology and neurology. Each general medical service is comprised most often of
attending physicians, one resident, one PGY I trainee and one clerk. Residents undergoing specialty
experience, elective trainees and elective clerks may also be attached to the units. All units except
cardiology and neurology admit general medical patients from Emergency and as electives on a rotating
basis. However, each unit also has certain subspecialty interests. The attending physicians on Clinical
Training Unit I are nephrologists.
The attending physicians on CTU II include endocrinologists, infectious disease specialist, a general
internist. The attending physicians on CTU III include hematologists, a general internist and oncologists. The
attending physicians on CTU IV include gastroenterologists and respirologists. Most of these physicians also
practice internal medicine.
At St. Clare's Mercy Hospital, there are four general medical units. Again these units include attending
physicians who are general internists and subspecialists. A subspecialty clinical unit in rheumatology is also
available for elective rotations.
Ambulatory care is a compulsory part of each rotation at the Health Sciences Centre. This experience is also
available through some clinics at St. Clare's Mercy Hospital.
Each affiliated hospital provides weekly teaching conferences. At the Health Sciences Centre there are
subspecialty rounds three times per week, weekly medical grand rounds and semi-monthly medical
pathology conferences. A basic science lecture series is integrated into the round format. St. Clare's Mercy
Hospital provides medical grand rounds, clinical pathological conferences and a weekly teaching session, as
well as a subspecialty round in rheumatology.
The trainee is expected to be involved in the presentation of his/her patients' case histories at the various
formal rounds.
III. ORIENTATION
PGY I trainees receive an orientation as a group at the beginning of the year and as each trainee joins a
clinical teaching unit a further orientation is provided by PGY coordinator or administrative resident(s) in
internal medicine, the resident and/or attending staff provide individual orientation to the service and to the
hospital as is appropriate. A written orientation that includes responsibilities within the medical care team of
the unit is provided to the trainee at the beginning of a rotation.
On each clinical teaching unit the trainee is responsible for the clinical evaluation of new admissions
(emergency or elective) assigned by the resident or attending physician and, from this information, to
analyze the medical and psycho-social problems in order to develop an appropriate investigational and
therapeutic approach. The trainee is also responsible for the continuing care of any patient assigned to
him/her. These activities take place under the supervision of the medical resident and/or attending
physician. Trainees are responsible for undertaking medical investigational procedures on their patients
under the supervision and at the discretion of the resident and/or attending physician. The trainee should
assess as many emergency patients' admissions in the Emergency Room as possible.
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IV. EVALUATION
This is an ongoing process during the rotation. The trainee is provided with verbal feedback during the
rotation by the resident and attending physician through case review and service teaching rounds. At the
end of each four-week period, the trainee is provided with an in-training evaluation report from the attending
physicians and residents on the clinical teaching unit. Since the trainee is required to sign this evaluation, an
opportunity is provided for feedback at that time.
Because the period of training on any clinical teaching unit is so short, an attempt is made to quickly identify
trainees with specific problems in order that these may be rectified. It is also hoped that, if any trainee
recognizes that he or she faces problems that in any way jeopardize the learning experience provided on a
specific clinical teaching unit, these problems will be brought to the immediate attention of the PGY I co-
ordinator so that appropriate action may be taken.
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OBSTETRICS & GYNECOLOGY COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
The PGY I trainee will spend two months on a combined obstetrics and gynecology rotation. The rotation
has been designed to provide a learning experience as well as a portion of service commitment to the
trainee. The trainee is assigned to a team consisting of several attending staff physicians, a resident, a PGY
I trainee and a clinical clerk. The team provides experience and responsibility in patient care in ambulatory
clinics, inpatient obstetrics and gynecology, operating room and labour/delivery.
1. To develop awareness and insight into general obstetrical and gynecological problems encountered,
thus developing professional responsibility and expertise to assume the responsibilities of obstetric
and gynecological care in general practice.
2. To provide the trainee with the necessary insight and skill to recognize abnormalities and his/her
limitations in dealing with these abnormalities and the knowledge to decide when a referral for a
specialist consultation is in the patient's best interest.
3. To develop specific skills in the area of obstetrics and gynecology and to be able to undertake
antenatal, intrapartum and postpartum care.
4. To develop awareness of the special relation and ethical responsibilities which exist between a
physician and patient in obstetrics and gynecology, with specific regard to birth control and the
changing role of women in modern society.
In Addition to all those listed below it is expected at the end of the rotation you will be able
1. To conduct a normal delivery and repair an uncomplicated episiotomy or tear and manage the third
stage of labour.
2. To demonstrate an understanding of the indications for use of fetal monitors and recognize basic
abnormal patterns.
3. To demonstrate a current knowledge of indications for and side effects of analgesics and anesthetics
in labour and delivery.
1. Familiarity with the teratogenic potential of the various psychotropic medications is expected.
2. Recognize risk factors for postpartum depression and grieving from infertility and miscarriage.
1. To demonstrate a current knowledge of indications for and side effects of analgesics or anesthetics
in labour and delivery.
Knowledge:
Obstetrics
1. To demonstrate knowledge of the normal progress of pregnancy, specifically antenatal testing (MSS,
amnio etc.) and delivery and the common abnormalities found in a general practice.
3. To demonstrate knowledge of the effects of common medical problems on pregnancy and delivery,
and recognize when pre-conceptual counseling for a pre-existing medical problem is warranted.
4. To be aware of the special needs of both the mother and the infant during labour and the immediate
postpartum period - including potentially life threatening conditions i.e. postpartum hemorrhage,
gestational hypertension and venous thromboembolic disease.
Gynecology
1. To demonstrate an understanding of common gynecological conditions and of the appropriate
treatments.
2. To recognize the less common gynecological conditions and to know the indications for referral to a
specialist i.e pelvic inflammatory disease, abnormal Pap smear, pelvic pain and ovarian cysts.
Skills:
Obstetrics
1. To undertake to provide good prenatal care and assessment for patients.
2. To demonstrate the ability to recognize abnormalities and assess risk factors that arises anytime in
the prenatal period.
3. To demonstrate the ability to recognize the indications for a referral or consultation at the earliest
possible time.
4. To conduct a normal labour and vaginal delivery including third stage.
5. To assess progress of labour and recognize deviations from normal at the earliest possible time.
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6. To perform episiotomy and repair, if indicated.
7. To act effectively in the case of hemorrhage.
8. To manage routine postpartum care.
9. To perform an adequate post partum examination.
10. To recognize the particular emotional needs of the mother and family in the postnatal and
subsequent period.
11. To advise on subsequent family planning.
Gynecology
1. To perform an adequate pelvic examination, including Pap smear and cultures
2. To initiate appropriate infertility investigations.
COMMUNICATOR
1. To demonstrate the ability to establish a therapeutic relationship with patients and their families.
3. To demonstrate the ability to effectively deliver information back to patients and families.
4. To demonstrate the ability to deliver information to colleagues and members of the health care team.
i. counseling patients with specific medical problems with regard to their outcome in pregnancy
and optimizing their status prior to conception.
ii. Counseling a pregnant patient in matters of family involvement, nutrition activity and
medication throughout the pregnancy.
iii. Counseling for sterilization.
iv. Counseling with regard to continuation or termination of pregnancy.
COLLABORATOR
1. To know and respect the appropriate roles and skills of members of the health care team.
2. To demonstrate the ability to work effectively within the health care team.
3. To be conscious of the needs of others including fellow staff members and patients.
HEALTH ADVOCATE
1. To obtain consultation in an appropriate and timely way.
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2. To understand the health advantages of and advise on infant nutrition - breastfeeding or other
methods.
MANAGER
1. To understand the impact of the cost of treatment.
2. To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
PROFESSIONAL
1. To recognize and deal with one's own anxieties, limitations and personal prejudices.
SCHOLAR
1. To demonstrate an ability to recognize learning needs.
2. To critically appraise sources of medical information.
3. To actively participate in learning opportunities.
4. To facilitate learning of patients, other house staff/students and others.
Attempts are made to ensure equitable division of labour with regard to the service commitment. It must be
recognized, however, that the majority of teaching is through the experience gained in management of
patients and in bedside discussions, and thus the service component is an integral part of learning in
obstetrics and gynecology. Indeed, obstetrics and gynecology being essentially practical subjects, it is not
possible to over-emphasize the importance of the service element of this rotation in terms of learning.
However, it is hoped that the service commitment will be undertaken in the overall perspective of team work.
Patient Management - The trainee will be a member of a team comprised of a staff member, resident and
clinical clerk who are responsible for the day-to-day management of the patients on the service. In order to
gain experience, it will be necessary to take part in the management plan of the patients and to execute the
plan devised by the team as far as possible and to make use of bedside teaching and work rounds. Because
of the nature of the specialty, ward rounds cannot be carried out at the same time on a daily basis.
Practical Obstetrics and Gynecology - It is important that the trainee expand his/her experience beyond
the routine workload and to this end he/she should be aware, as far as possible, of practical problems and
associated medical conditions which are being managed within the unit, although these may not be on the
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team to which he/she is assigned. Trainees will be expected to familiarize themselves with any unusual
cases on the service in order to augment their experience. They will be expected to participate in the care of
patients antenatally and postpartum. Intrapartum care of patients is dependent on specialty and we
encourage trainees to participate however it is not mandatory to perform an obligate number of deliveries.
We do expect trainees to be familiar with the progress of labour and delivery, that in event of an emergent or
precipitous vaginal delivery they could safely perform it. They should also become aware of fetal monitoring
techniques, and be able to determine abnormal versus normal fetal tracing, as pertains to transport of a
patient form the periphery or for the antenatal floor, especially in the high-risk patient, both prior to and
during labour. Pelvic examinations are to be carried out with the guidance of the resident on duty or the staff
person; this applies particularly in the case room. In the case of gynecology patients, pelvic examinations
are done, where practical, following the admission history and physical under the guidance of the resident.
Trainees are encouraged to come to the operating room, with the guidance of the staff person, where more
adequate pelvic examinations may be carried out, under general anesthetic. Trainees are expected to be
present in the OR for all cases they have admitted or which are on their service.
Outpatient Experience - Outpatient clinics in obstetrics and gynecology are held five days a week at the
Women’s Health Centre. The trainee is expected to attend these outpatient clinics to obtain further
knowledge and experience in the management of antenatal, postnatal and gynecological outpatients such
as one would find in general practice. He/she is also expected to attend calls to the Emergency Department
with the resident and participate in the diagnosis and management of these cases, which may be treated on
an outpatient basis or admitted to the hospital as the situation warrants.
Didactic Teaching - At the Women’s Health Centre, there are grand rounds and high risk rounds each
week, and the trainee is expected to attend these sessions. There are also weekly rounds in neonatology,
pathology and radiology which are oriented to the trainees on the obstetrical and gynecological service.
EVALUATION
Trainees will be evaluated using the standard ITER forms. The evaluation is a team effort which is
performed at the regular meeting of the medical staff in the Department of Obstetrics and Gynecology.
V. SUMMARY
The obstetrical and gynecological program for PGY I trainees is reviewed. The objectives of their program
are defined. It is hoped that the trainees will take advantage of the wealth of material available both on the
inpatient service and in the outpatient clinics and Emergency Department, to gain experience and develop
expertise in the normal physiology and endocrinology of obstetrics and gynecology and become
experienced in the management of these problems, as well as the problems of reproduction control and the
development of the particular insight required to practice in this discipline.
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PEDIATRIC COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
The PGY I trainee's experience in pediatrics will include instruction in the assessment and care of
hospitalized patients from birth through adolescence and the assessment and management of ambulatory
patients of the same age.
The overall objective is to enable you to acquire the ability to assess and assist the well and the sick child as
an individual and within the family, to understand the responses of the child and family to these situations
and to efficiently and appropriately access the resources available. Please note it is the responsibility of the
trainee to ensure completion of the ITER by the appropriate Pediatrician and the prompt return of the ITER
and completed program evaluation form to the Postgraduate Medical Studies Office.
Attendance at any pediatric autopsies which occur during this rotation is expected.
Knowledge:
1. To demonstrate knowledge of signs and symptoms related to common pediatric disorders, including
emergencies, developmental, psychiatric and behavioural disorders.
Skills:
1. To demonstrate the ability to complete a focused history and physical examination.
2. To formulate and carry out an effective treatment plan for common pediatric disorders.
3. To demonstrate resuscitative skills.
4. To demonstrate effective use of investigations.
COMMUNICATOR
1. To demonstrate the ability to establish a therapeutic relationship with patients and their families.
3. To demonstrate the ability to effectively deliver information back to patients and families.
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4. To demonstrate the ability to deliver information to colleagues and members of the health care team.
COLLABORATOR
1. To know and respect the appropriate roles and skills of members of the health care team.
2. To demonstrate the ability to work effectively within the health care team. 3. To be conscious of the
needs of others including fellow staff members and patients. 4. To contribute effectively to
interdisciplinary team activities.
HEALTH ADVOCATE
1. To identify important determinants of health as they affect particular patients.
3. To appreciate the impact of acute or chronic illness on child and family and provide empathetically
the appropriate information and support.
MANAGER
1. To understand the impact of the cost of treatment and judiciously use available resources.
2. To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
PROFESSIONAL
1. To be recognize and deal with one's own anxieties, limitations and personal prejudices.
SCHOLAR
1. To demonstrate an ability to recognize learning needs.
2. To critically appraise sources of medical information.
3. To actively participate in learning opportunities.
4. To facilitate learning of patients, other house staff/students and others.
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IV. RESOURCES AVAILABLE TO ASSIST THE PGY I TRAINEE IN ACHIEVING OBJECTIVES
FACILITIES
Facilities include wards, laboratories and ambulatory service at the Janeway Children’s Health and
Rehabilitation Centre for a total of 110 medical and surgical beds, which approximately half are medical, but
this varies from time to time according to need.
In addition to this, the Emergency and Out-Patient Departments have approximately 65,000 visits during the
year. Of this, about 35,000 are seen in the Emergency Department (where a period of time is spent by the
PGY I trainee) and 30,000 are seen in clinics that include ENT, Orthopedics, Developmental, Neurology,
Nephrology, etc.
IV. ORIENTATION
Trainees receive an orientation as a group at the beginning of the year. Then as each trainee joins the
Janeway Children’s Health and Rehabilitation Centre, the discipline coordinator or the physician in charge of
the ambulatory service will provide orientation to the service and to the hospital as appropriate.
V. METHODS OF EVALUATION
Evaluation is an ongoing process during the rotation. The trainee is provided with verbal feedback during the
rotation by the resident and attending physician through case review and session teaching rounds. At the
end of each four week period the trainee will meet with the attending pediatrician and will be provided with
an ITER. This interview at the end of the rotation will provide a forum for mutual feedback.
Evaluation is based on the quality of work done together with attitude factors, which include
conscientiousness, dependability, acceptance of responsibility for patient care, avoidance of careless errors,
sensitivity to patients' feelings and willingness to receive constructive criticism.
The trainee is asked to discuss and submit an evaluation of his/her experience within the hospital, indicating
areas in which he/she feels there are deficiencies or in which the experience appears to be exceptionally
useful.
The discipline coordinator and/or team leader and/or assigned pediatrician to the trainee will welcome any
trainee who wishes to approach them regarding any concerns that needs to be addressed during the
rotation.
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PSYCHIATRY COMPONENT OF THE PGY I PROGRAM
I. INTRODUCTION
It has been our view that the undergraduate teaching and training do not, by themselves, prepare the
student adequately for independent medical practice, and there is a need to continue the teaching and
training in clinical psychiatry from the clerkship program into the PGY I program. During the PGY I program,
clinical experience should be offered on a broader and more advanced level than the one gained during the
clerkship.
The overall objective of the training and teaching is to equip the trainee with skills, attitudes and knowledge
of clinical psychiatry which are of help to non-psychiatric physicians. These include the ability to co-operate
effectively with the psychiatrist and other mental health workers in the care of patients who have psychiatric
disorders and who live in the community. The program will specifically aim to achieve the following:
1. To expand and consolidate the knowledge, clinical skills and abilities gained during the clinical
clerkship.
2. To provide clinical experience:
a. consultation-liaison psychiatry,
b. ambulatory care,
c. community care,
d. crisis management and emergency psychiatry, and
e. inpatient psychiatry care.
3. To increase the trainee's knowledge of and ability to deal appropriately with the intimate relationship
between emotional and physical illness.
4. To provide the trainee with sufficient knowledge and skills to be competent in the detection and
management at a primary care level of the most frequent forms of mental disorder, including a
knowledge of:
a. available and appropriate community adjuncts to treatment, and
b. appropriate indications for specialist consultation.
Knowledge:
1. To demonstrate knowledge of the signs and symptoms of major mental disorders, in particular,
disorders of emotion, thinking and cognition.
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3. To demonstrate appreciation for the psychological, familial and social factors that can influence the
presentation and management of both mental and physical illnesses.
4. To demonstrate knowledge of the indications for and the risks and benefits of psychiatric care,
specifically:
i) forms of psychotherapy,
ii) physical treatment, including the use of anxiolytics, antidepressants, ECT, and antipsychotics,
iii) formal and informal community support systems, and
iv) transfer, restraint, and civil commitment procedures.
Skills:
1. To demonstrate the ability carry out a comprehensive psychiatric assessment, specifically including
an evaluation of a patient's mental state, physical status and familial/social circumstances.
2. To detect significant mental disorders as well as mental influences upon a person's state of physical
health.
3. To accurately identify emergency and crisis situations and to carry out crisis intervention.
i) the diagnosis,
ii) the urgency of the situation, and
iii) the available family, social and health care resources most appropriate to the situation,
including indications for admission.
COMMUNICATOR
1. To demonstrate the ability to establish a therapeutic relationship with patients and their families.
3. To demonstrate the ability to effectively deliver information back to patients and families.
4. To demonstrate the ability to deliver information to colleagues and members of the health care team.
COLLABORATOR
1. To know and respect the appropriate roles and skills of members of the health care team.
2. To demonstrate the ability to work effectively within the health care team.
3. To be conscious of the needs of others including fellow staff members and patients.
HEALTH ADVOCATE
1. To know the distribution and impact of mental disorder in the population.
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2. To identify important determinants of health as they affect particular patients.
MANAGER
1. To understand the impact of the cost of treatment.
2. To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3. To be attentive to preventative measures.
PROFESSIONAL
1. To be recognize and deal with one's own anxieties, limitations and personal prejudices.
SCHOLAR
1. To demonstrate an ability to recognize learning needs.
2. To critically appraise sources of medical information.
3. To actively participate in learning opportunities.
4. To facilitate learning of patients, other house staff/students and others.
IV. PROCEDURE
The rotation through psychiatry will extend over a four-week period. Each trainee will spend the entire four
weeks in one of the following settings:
The allocation, while taking the preferences of the trainee into account, will be made by the PGY I co-
coordinator to prevent overloading of any particular setting and secure a rotation profitable to the trainee.
(Trainees wanting to undertake an elective program must satisfy the PGY I co-coordinator that they have an
adequate knowledge of general psychiatry).
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The services in the different hospitals vary. The trainee will be briefed about his/her program on joining the
unit in question. However, common to all rotations will be:
4. Participation in grand rounds and other formal teaching activities of the unit and the university.
5. Involvement in the various activities of the service on which the trainee is working, e.g., group
meetings, therapeutic community programs.
The Waterford Hospital is the main psychiatric hospital in the province; it has several programs in place.
1. Acute service.
2. Ambulatory care service, including addictions, community care and day care.
In order to spend these four weeks profitably, a trainee will be attached to Acute Service under the guidance
of the director of training or one of the staff psychiatrists. Learning the distinction between minor and major
psychiatric disorders will be a major focus on this program. As far as formal case presentations or
conferences are concerned, the trainee would attend Grand Rounds every other week and in the intervening
period a local case presentation would be required. Arrangements could also be activated for one or two
seminars with social workers and psychologists if the trainee felt this would be an appropriate learning
experience.
VII. ELECTIVES
Following the satisfactory completion of a general psychiatry rotation, the trainee may undertake a
specialized psychiatric rotation. Trainees shall not normally be permitted to do psychiatry electives of less
than four weeks duration unless those electives are continuous with and in the same hospital setting as their
psychiatry rotation. For specialized rotations, the trainee shall obtain the prior approval of the staff person
involved, the PGY I co-coordinator for psychiatry and the office of Postgraduate Medical Studies.
GERIATRIC PSYCHIATRY
This service, based at the Miller Centre, consists of a day hospital, consultation-liaison service and
community psychiatry program for the elderly. The trainee will participate in all three programs.
Objectives
1. Exposure to and understanding of psychiatry illness in late life, including assessment, management
and service co-ordination.
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2. Ability to carry out functional assessments.
3. Knowledge of support services and agency co-ordination.
FORENSIC PSYCHIATRY
The Waterford Hospital has an inpatient forensic unit. The trainee will get experience in the assessment of
court referrals and in the preparation of court reports. Management of forensic patients will also be part of
this experience.
Electives are available in child psychiatry. The rotation is based in the Psychiatry Department of the
Janeway Children’s Health and Rehabilitation Centre. The department provides psychiatric services for
children and young adolescents for the entire province. About 500 new patients are seen and 100 inpatients
are admitted annually.
The trainee will be exposed to all aspects of diagnostic assessment, decision making and management in
child psychiatry. The PGY I experience will emphasize the following areas:
Outpatient Diagnostic Assessment: The trainee will assess at least two families a week under
supervision, following orientation to the procedure. The trainee will become familiar with the role of a social
worker and in using the expertise of the psychologist in diagnostic assessment. The trainee will learn to
conduct sensitive family interviews and to interview children to elicit relevant information. Home visits and
school visits will be included whenever possible.
Consultation-Liaison: Opportunities to assess children on medical and surgical services referred for
psychiatric opinion. This enables doctors to appreciate the enormous contribution of psychological factors in
children's somatic symptomatology as well as the psychological problems secondary to chronic physical
disease.
Inpatient Service: The trainee will have the opportunity to assess children on an inpatient basis under the
supervision of a staff psychiatrist. Trainees will take part in the night call rotation under the supervision of a
staff psychiatrist.
VIII. EVALUATIONS
Trainees will be evaluated on their knowledge base, clinical skills, attitudes and any other factors deemed
appropriate.
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SURGERY COMPONENT OF PGY I PROGRAM
Trainees at the Health Sciences Centre are assigned to general surgery, neurosurgery, urology or
orthopedics. Orthopedics and neurosurgery have their own separate call schedules distinct from general
surgery and the other subspecialties.
The trainees assigned to general surgery do call on a 1-in-4 rotation with other residents. When on call, this
team covers only general and plastic surgery. The trainee or resident is on first call to the emergency room
and is always backed up by the chief resident in general surgery, who does not do in-hospital calls. The staff
surgeon is always available.
The trainees assigned to neurosurgery do call on a 1-in-3 to 1-in-4 rotation. When on call, members of this
team would cover only neurosurgery, including calls to the emergency room.
I. PROGRAM OBJECTIVES
1. To encourage development of professional responsibility by providing definite service duties that will,
in addition, provide benefit to the patients and allow for a wide range of case study material for the
trainee.
2. To develop specific skills in surgical management so that the trainee will be better able to fulfill their
role as a physician.
1. Know the procedures for submitting surgical specimens to the laboratory and the special
requirements for specimens such as lymph nodes, breast biopsies, lungs and muscle biopsies.
Knowledge:
1. To recognize common problems that require surgical treatment.
2. To demonstrate knowledge of common surgical procedures, including indications for and effects of
surgical intervention.
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5. To demonstrate understanding of common medical problems that constitute added risk - diabetes,
COPD, medications CHF, IHD, etc.
7. To recognize and know the management of common complications of surgery - deep venous
thrombosis, pulmonary embolism, atelectasis, pneumonia, wound infection, etc.
8. To demonstrate knowledge of those special diagnostic investigations and techniques used, for which
a patient may require instruction or preparation for the procedure, e.g. IVP, GI series, ultrasound,
angiography, CT scan, gastroscopy, sigmoidoscopy, bronchoscopy, etc.
Skills:
1. To demonstrate the ability to assess priorities accurately in cases of major trauma and take
appropriate action within the limitation of available facilities and assistance.
2. To manage the resuscitation of major trauma victims, particularly those with injury to the head, spine,
chest and abdomen.
6. To demonstrate the ability splint and immobilize limbs or fractures properly, prior to transportation.
7. To demonstrate skill in the removal of a skin and superficial lesion, repair of superficial wounds, I and
D of subcutaneous abscesses, etc.
COMMUNICATOR
1. To demonstrate the ability to establish a therapeutic relationship with patients and their families.
2. To demonstrate the ability to perform a focused history.
3. To demonstrate the ability to effectively deliver information back to patients and families.
4. To demonstrate the ability to deliver information to colleagues and members of the health care team.
5. To complete written documentation clearly and effectively in a timely manner.
COLLABORATOR
1. To know and respect the appropriate roles and skills of members of the health care team.
2. To demonstrate the ability to work effectively within the health care team.
3. To be conscious of the needs of others including fellow staff members and patients.
MANAGER
1. To be aware of the cost of various diagnostic and treatment modalities.
2. To demonstrate an understanding of the indications for and the effects of admitting a patient to
hospital.
3. To be able to work as part of a health care team.
4. To further develop time management skills.
PROFESSIONAL
1. To recognize and deal with one's own anxieties, limitations and personal prejudices.
SCHOLAR
1. To demonstrate an ability to recognize learning needs.
2. To critically appraise sources of medical information.
3. To actively participate in learning opportunities.
4. To facilitate learning of patients, other house staff/students and others.
It must be recognized that trainees perform an important and major hospital service. This aspect of their
work has occasionally been abused. Care must be taken to ensure that the inevitable demands for routine
service work are either limited or rewarded by active teaching. It is the view of the surgical PGY I co-
80
coordinator that the only experience of no value to a PGY I trainee is a large volume of routine work which is
conducted in complete isolation from other medical staff.
The service load of the trainee will be limited to that set out below in achievement of educational objectives.
GENERAL SURGERY
The general surgical unit is on the 4th floor of the Health Sciences Centre. The ward is shared with the
Plastic Surgery service and the house staffs on General Surgery and Plastics cross-cover at nights and
weekends.
The normal complement of house staff is: one chief resident, two assistant residents and two clinical clerks
on General Surgery and one or two residents on Plastics.
The PGY I trainee takes call in rotation, which is normally one night in four, and has the opportunity to see
patients in the Emergency Room and to discuss them directly with his staff person on call.
The service offers a complete mix of general surgical patients. The Plastic Service is heavily weighted in
favour of hand and facial trauma and the on-call cover offers a unique opportunity to learn the basic
principles in managing these areas.
The General Surgery service has particular strength in the management of major trauma, endocrine surgery,
laparoscopic surgery and in surgical oncology. In addition, there is a good opportunity to gain exposure to
vascular access surgery. The Health Sciences Centre is the Provincial Referral Centre for major trauma and
burns
Attending Staff
Dr. D. Boone Dr. A. Kwan Dr. M. Wells
Dr. M. Hogan Dr. D. Pace
Resources
The five general surgeons are full-time University professors. Each of the general and plastic surgeons has
one half-day clinic per week. The PGY I trainee is expected to attend the General Surgery clinics.
Each surgeon has one full-day for elective surgery in addition to time in Day Surgery for minor procedures
and time in the endoscopy unit.
Formal Teaching
1. Surgical rounds are held weekly on Tuesday mornings at 0745 hours in Lecture Theatre B. These
are usually case-based discussions and oriente3d to participatory teaching of the house staff and
surgeons.
2. Surgical resident seminars are Friday afternoons at 1530 hours. These sessions are directed to
General Surgery resident but any PGY I trainee is welcome to attend, and are usually held at St.
Clare’s Mercy Hospital, Morrissey Wing, third floor.
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3. There is a schedule for clinical clerk teaching done a weekly basis and PYG I trainees are welcome
to attend.
4. Principles of Surgery rounds are on Wednesdays at 1600 hours. They may be held in Lecture
Theatre B, the Anatomy Lab or the Surgical Research Lab, according to the schedule posted on the
Surgery website. These sessions are for junior residents and any PGY I trainee who is interested in
attending.
5. All General Surgery Rounds except those directed at clinical clerks are listed under “News & Events”
on the Discipline of Surgery website. The clerkship Teaching Schedule may be obtained from the
Office of Surgical Education, 777-6874 or cperkins@mun.ca. While PGY I’s are on a General
Surgery rotation, the rounds they are expected to attend should be on their One45 calendar.
2. To demonstrate knowledge of the general conduct of surgical operations including principles of asepsis
and perioperative therapy.
3. Be able to perform, under supervision, simple suturing and surgery of “lumps and bumps”.
4. To know the principles in surgical and non-operative management of trauma, gastro-intestinal disease,
breast and thyroid disease and surgical oncology.
5. To demonstrate communication skills with patients and families including the breaking of bad news and
discussion of prognosis.
7. To know the principles in post-operative care including the recognition of complications and the
management of the more common ones.
8. To recognize and know the principles in treating sepsis, the acute abdomen, major trauma and the
common cancers of the breast and G.I. tracts.
ORTHOPEDIC SURGERY
The trainee is exposed to the management of major and minor trauma cases as well as elective orthopedic
cases. There are daily clinics where the house staff see both new and re-check patients and gain
experience in the examination, treatment and follow-up of various orthopedic conditions.
The workload and teaching is shared with orthopedics and/or general surgery residents and clinical clerks.
Trauma rounds are held weekly and attendance at these is expected. Other orthopedic surgery rounds as
listed under “News & Events” on the Discipline of Surgery’s website.
Attending Staff
Dr. A. Furey Dr. F. Noftall Dr. D. Squire
Dr. G. Hogan Dr. F. O’Dea Dr. C. Stone
Dr. R. Martin Dr. P. Rockwood
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NEUROSURGERY
A clinical associate is generally assigned to this service. This is a busy clinical service and regular teaching
activities are available. These include neurosurgery and neurology rounds, a didactic series of lectures
conducted by Dr. Maroun, and the various other surgical teaching rounds within the General Hospital.
Attendance in the operating room is not essential but the surgeons do make a point of having the house staff
come to see relevant pathology. There is excellent exposure to clinical problems in OPD (4 clinics per
week).
Attending Staff
Dr. R. Avery Dr. F. Maroun
Dr. A. Engelbrecht Dr. G. Murray
UROLOGY
The service offers a highly organized, highly structured rotation with daily teaching rounds and tutorials. The
clinical responsibility given to the trainee is high, allowing familiarization with a wide range of urological
pathology. Trainees who have completed the service rate it highly because of the responsibility given to
them and the relevance of what they learn to almost any area of medicine in which they might choose to
practice.
Attending Staff
Dr. L. Best Dr. G. Duffy Dr. R. Hewitt
Dr. D. Drover Dr. C. French
GENERAL SURGERY
The general surgical service at St. Clare's Mercy Hospital is very busy and accommodates, in addition to
general surgery, a large volume of vascular surgery, thoracic surgery, plastic surgery and endoscopy. One
or two trainees are assigned and the heavy individual case load, as well as the wide variety of major and
minor surgical cases encountered, makes this a very satisfactory and popular rotation.
2. Surgical rounds are held weekly on Tuesday mornings at 0745 hours in Lecture Theatre B at the
HSC. These are usually case-based discussions and oriented to participatory teaching of the house
staff and surgeons.
3. Surgical resident seminars are Friday afternoons at 1530 hours. These sessions are directed t to
General Surgery residents but any PGY I trainee is welcome to attend, and are usually held at St.
Clare’s Mercy Hospital, Morrissey Wing, third floor.
4. There is a schedule for clinical clerk teaching done on a weekly basis and PGY I trainees are
welcome to attend.
83
5. Principles of Surgery rounds are on Wednesdays at 1600 hours. They may be held in Lecture
Theatre B, the Anatomy Lab or the Surgical Research Lab, according to the schedule posted on the
Surgery website. These sessions are for junior residents and any PGY I trainee who is interested in
attending.
6. All General Surgery Rounds except those directed at clinical clerks are listed under “News & Events”
on the Discipline of Surgery website. The Clerkship Teaching Schedule may be obtained from the
Office of Surgical Education, 777-6874 or cperkins@mun.ca. While PGY I’s are on a General
Surgery rotation, the rounds they are expected to attend should be on their One45 calendar.
7. Vascular Surgery Rounds are held on Mondays, 0730 hours in the 5E Conference Room, SCM. In
addition to the one or two trainees, there is always a chief resident as well as two or three junior
residents in general surgery. Two or three clinical clerks, as well, are assigned to the staff surgeons
at St. Clare's Mercy Hospital. Trainees work a call rotation with the residents; the chief resident and
the staff surgeon on call are always available. There are two general surgery teams, one
general/thoracic team and one vascular team.
Attending Staff
Team A (General) Dr. A. Felix Dr. W. Pollett
ORTHOPEDIC SURGERY
The PGY I trainee (or family practice resident) will gain experience in the multi-disciplinary approach to
orthopedic diseases, with greater emphasis on elective conditions and some trauma.
Daily orthopedic clinics are organized for teaching, and house staff can gain experience in simple orthopedic
procedures and cast application. The workload is shared with orthopedics and/or general surgical residents
and clinical clerks.
Attendance and participation is expected at Tuesday am (HSC), Thursday am (HSC) and Friday am (JCH)
teaching rounds.
Attending Staff
Dr. A. Furey Dr. F. Noftall Dr. D. Squire
Dr. G. Hogan Dr. F. O’Dea Dr. C. Stone
Dr. R. Martin Dr. P. Rockwood
VI. ELECTIVES
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Plastic surgery at the Health Sciences Centre is a separate service. A wide variety of general plastic surgery
as well as microvascular, hand and cosmetic surgery is performed. Rotating trainees are not regularly
assigned to this service but are welcome as elective students.
Many outpatient minor operative procedures which are done through day care surgery, the chance for the
trainee who often times will first assist on more major cases in the main operating room and the willingness
of the staff surgeons to teach, make this surgery elective quite attractive to the trainee.
Attending Staff
Dr. J. Cluett Dr. D. Jewer
Dr. D. Fitzpatrick Dr. A. Rideout
Pediatric Surgery is available as an elective surgical rotation. There is a great deal of clinical material
available on the surgical service, material which is usually only seen in a pediatric hospital.
Regular teaching rounds are carried out three times a week. There is a grand surgical round rotating with all
specialties in pediatric surgery weekly. Mortality rounds are held once a month and there is a one-hour
teaching session each week correlating embryology, physiology and anatomy with pediatric surgical
problems.
Electives can be arranged by contacting Dr. David Price, Chief of Surgery, Janeway Children’s Health and
Rehabilitation Centre.
1. Inpatient Bedside Service: The trainee must be the member of the surgical team who is
responsible for the day-to-day bedside management of the surgical patients. In this, he/she is
supervised and assisted by the residents and staff persons and in turn supervises and is assisted by
the clinical clerks.
Trainees must be involved in formulation of plans of management. As far as possible, orders should
be channeled through the trainee. There should be regular informal bedside teaching and work
rounds.
2. Operating Room: Trainees should go to the OR with most of the patients under their care. They
need not always be present throughout the procedure but should always consult with the resident or
staff person if they feel that their presence is of no use or their time would be better spent on the
ward. The surgeons must get used to the idea of getting trainees out of the OR when there is no
point in their presence.
3. Outpatient Clinic Attendance: Some staff persons have well-organized clinics and can
demonstrate principles of outpatient care. These clinics should always be attended by trainees.
Please see Appendix Two: A guide to Developing Good Clinical Skills and Attitudes for more information.
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SECTION 3
Specific Rotation Objectives
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Angiography/Interventional Radiology
SUPERVISOR: Dr. Peter Collingwood, HSC
The following is an outline of the goals and objectives of the Interventional Radiology rotation during PGY3,
incorporated into CANMEDS format. The CANMEDS roles will be assessed throughout all rotations and will
remain consistent throughout all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
•To understand the rationale for interventional procedures for each patient.
•To have an expectation of expected positive outcomes and possible complications.
•To fully understand the anatomy of the organ systems involved in each intervention.
•To be able to obtain informed consent and discuss the case appropriately with the patient and family
members if necessary.
• To review requests for in-patient procedures and to make recommendations as to the appropriate
investigation and intervention with the approval of the staff interventionalist.
• To be exposed to a wide variety of angiographic and interventional procedures as possible during the
rotation and participate in the procedures with the staff interventionalist.
• To understand interventional techniques.
• To report these examinations in a timely fashion under the supervision of the staff interventionalist.
• To supervise the pre and post-procedure care of inpatients and outpatients in conjunction with the
staff radiologist.
ONE 4-WEEK ROTATI2 (OR SECOND 4-WEEK ROTATION)
(Copies of the suggested reading can be obtained through either Dr. Heale or Dr. Collingwood)
1. Medical Expert
Have thorough working knowledge of the anatomy of the vascular, biliary and urologic systems and
other necessary anatomy. The vascular anatomy includes the aorta and its major branches as well
as the vascular anatomy of the brain and neck.
Understand the pathophysiology of atherosclerosis and be familiar with the techniques of vascular
recanalization including angioplasty stenting and thrombolysis.
87
Become competent in basic interventional techniques especially with respect to accessing the
femoral artery and central and peripheral veins to gain some understanding of basic interventional
devices.
Understand the various central venous access techniques and devices used in IR.
Understand the rationale for catheter neuroangiography and be able to identify the major vessels.
Become familiar with conscious sedation and analgesia and be able to manage complications of
intravenous sedation.
Become familiar with contrast injection rates and volumes for angiographic procedures.
Be able to independently perform an angiograph examination of the abdominal aorta and lower
extremities.
Gain knowledge of how to perform an angiographic procedure including contrast injection volume
and rates and the indications for antibiotic prophylaxis.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish effective relationships with patients and be able to obtain informed consent for
interventional procedures.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information. Handles conflict situations well.
Produce succinct reports that describe findings, most likely diagnosis and interventions performed.
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3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition residents will be required to be active participants in inter and intra
discipline rounds.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the benefits and risks of interventional investigations including the risks and benefits of
interventional radiology procedures versus surgical options.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (mammography, lung cancer, colon cancer, cardiac
calcification and total body).
6. Scholar
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Understand the importance of self responsibility and the responsibility a radiologist has to patients,
referring physicians and the community.
Have a personal commitment of continued education and demonstrate a commitment to the need for
continuous learning.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design with respect to Radiology.
The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long
term plan. For a resident, this would include seeing as many cases as possible during the days with
follow-up reading performed at night.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
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Body Imaging (HSC): Introductory Month – PGY2
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Body Objectives in PGY5 below)
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Interpret daily body CT’s and review with staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Understand the basic physics of CT including pitch, slice thickness, mA and kV, scanner types.
Learn principles and effects of contrast enhancement, timing and its applications.
Be able to recognize and effectively treat all forms of adverse contrast reactions.
Be studied in CT anatomy.
Understand the importance of radiation dose & when it is appropriate (or Not) to use CT as a diagnostic tool.
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REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols. Silverman PM.
Lippincott-Raven.
1. Medical Expert
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
- Triple phase CT of the liver/kidneys,
- Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or
pancreatic tumor )
- CT urogram
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- Adrenal washout study
- CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Adequately assess & interpret CT images of the intra-abdominal & pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which
in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body
MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Fatty infiltration of the liver
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Ascites
- Gallbladder wall thickening
- Solitary and multiple splenic masses
- Splenomegaly
- Pancreatic mass
- Pancreatitis
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes
- Masses of the renal collecting system and bladder
- Hydronephrosis
- Nephrolithiasis/Nephrocalcinosis
- Omental caking/Peritoneal disease
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
93
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Interpret daily body CT’s and review with staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
94
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
1. Medical Expert
Be able to identify:
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial
planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in
turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI
studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
95
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Fatty infiltration of the liver
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Ascites
- Gallbladder wall thickening
- Solitary and multiple splenic masses
- Splenomegaly
- Pancreatic mass
- Pancreatitis
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes
- Masses of the renal collecting system and bladder
- Hydronephrosis
- Nephrolithiasis/Nephrocalcinosis
- Omental caking/Peritoneal disease
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
96
Body Imaging (HSC): PGY4
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Body Objectives in PGY5 below)
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Interpret daily body CT’s and review with staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
To expand on the knowledge of CT anatomy and Pathology obtained in the first 2 rotations.
Be able to correlate CT and MRI findings and determine how they relate to each case and patient diagnosis.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
97
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols.
1. Medical Expert
- CT angiography
- CT Urography
- CT Enterography
- Endovascular stent placement and endoleak
- Renal artery stenosis
- Complicated Bowel obstruction
- Pneumatosis intestinalis
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial
planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in
turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI
studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Fatty infiltration of the liver
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Ascites
- Gallbladder wall thickening
- Solitary and multiple splenic masses
98
- Splenomegaly
- Pancreatic mass
- Pancreatitis
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes
- Masses of the renal collecting system and bladder
- Hydronephrosis
- Nephrolithiasis/Nephrocalcinosis
- Omental caking/Peritoneal disease
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
99
Body Imaging (HSC): PGY5
SUPERVISOR: Dr. Diane Colbert, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while
maintaining professionalism, adequate communication and interpersonal skills. Residents must be
able to establish a therapeutic relationship with patients and communicate well with patients,
families and medical staff (including technologists, house staff and clinicians) while providing clear
and thorough explanations of diagnosis and management.
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Interpret daily body CT’s and review with staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
To expand on the knowledge of CT anatomy and Pathology obtained in the first 3 rotations.
Assist other residents in their interpretation, teaching and management of the daily CT worklist.
Be able to correlate CT and MRI findings and determine how they relate to each case and patient diagnosis.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial
planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in
turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI
studies
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT
studies:
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Fatty infiltration of the liver
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Ascites
- Gallbladder wall thickening
- Solitary and multiple splenic masses
- Splenomegaly
- Pancreatic mass
- Pancreatitis
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes
- Masses of the renal collecting system and bladder
- Hydronephrosis
- Nephrolithiasis/Nephrocalcinosis
- Omental caking/Peritoneal disease
101
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
102
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to
choose the most appropriate investigation.
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
103
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
104
Body Imaging (SCM) need to put in updated ones
SUPERVISOR: Dr. Connie Hapgood, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation.
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging
and MRI.
Residents will review all CT/MRI requisitions with the responsible staff radiologist when able and record the
examination plan on the requisition.
The resident will review each CT/MRI examination, present it to the staff radiologist for discussion, and
dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage
under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT
guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
1. Medical Expert
Know the indications, limitations/complications and be able to plan, interpret, and report the following
CT studies:
Become familiar with assessment of the aorta for complications when the patient has had an
endovascular aortic repair.
105
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of
trauma.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which
in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body
MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Fatty infiltration of the liver
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Ascites
- Gallbladder wall thickening
- Solitary and multiple splenic masses
- Splenomegaly
- Pancreatic mass
- Pancreatitis
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes
- Masses of the renal collecting system and bladder
- Hydronephrosis
- Nephrolithiasis/Nephrocalcinosis
- Omental caking/Peritoneal disease
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver
disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses,
mesenteric masses and masses affecting the uterus and ovaries.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
106
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to
choose the most appropriate investigation.
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
108
Pulmonary and Cardiovascular Radiology: PGY2
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Chest Objectives in PGY5 below)
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY2, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac
studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
* On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
109
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments. All
needed texts and articles are provided and scaled to the resident’s level.
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
1. Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
• Lobar collapse
• Solitary pulmonary nodule
• Multiple pulmonary nodules
• Interstitial lung disease
• Airspace disease
• Mediastinal mass
• Pleural fluid
110
• Pleural mass
• Chest wall mass
• Pulmonary vascular disease
• Cardiac disease: valvular, congenital, myocardial, pericardial
• Anomalies/abnormalities of the aorta
• Elevation of the diaphragm
• Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY3, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac
studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
* On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
112
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
1. Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
• Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
• Lymphoma
• Lung cancer
• Metastatic disease to the chest including lymphagitic carcinomatosa
• Carcinoid
• Extrinsic allergic alveolitis
• Occupational lung disease (including silicosis and asbestosis)
• Idiopathic pulmonary fibrosis
• Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
• Sarcoidosis
• Alveolar proteinosis
• Pulmonary hemorrhage syndromes
• Wegener’s granulomatosis
• Eosinophillic pneumonia
• BOOP
• Pulmonary edema
• Pulmonary hypertension
• Pulmonary embolism
• Pneumothorax
• Mitral stenosis/regurgitation
• Aortic stenosis/regurgitation
• Aortic aneurysm
• Aortic dissection
• Right-sided aortic arch
• Congestive heart failure
• Thymoma
• Superior vena cava obstruction
• Pulmonary hematoma
• Pulmonary sequestration
• Bronchogenic cyst
• Pericardial effusion
• Mesothelioma
• Benign pleural fibroma
• Anomalous coronary artery
• Bicuspid aortic valve
• Ascending thoracic aortic aneurysm
• Myocarditis
• Hypertrophic cardiomyopathy
• ARVD
• Partial Anomalous pulmonary venous return
• Atrial septal defect
• Myocardial Infarction
114
Pulmonary and Cardiovascular Radiology: PGY4
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC Chest Objectives in PGY5 below)
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY4, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT & MRI examinations including cardiac studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
Report consults.
* On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
115
REQUIRED READING LIST
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
1. Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
116
• Pleural fluid
• Pleural mass
• Chest wall mass
• Pulmonary vascular disease
• Cardiac disease: valvular, congenital, myocardial, pericardial
• Anomalies/abnormalities of the aorta
• Elevation of the diaphragm
• Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
• Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
• Lymphoma
• Lung cancer
• Metastatic disease to the chest including lymphagitic carcinomatosa
• Carcinoid
• Extrinsic allergic alveolitis
• Occupational lung disease (including silicosis and asbestosis)
• Idiopathic pulmonary fibrosis
• Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
• Sarcoidosis
• Alveolar proteinosis
• Pulmonary hemorrhage syndromes
• Wegener’s granulomatosis
• Eosinophillic pneumonia
• BOOP
• Pulmonary edema
• Pulmonary hypertension
• Pulmonary embolism
• Pneumothorax
• Mitral stenosis/regurgitation
• Aortic stenosis/regurgitation
• Aortic aneurysm
• Aortic dissection
• Right-sided aortic arch
• Congestive heart failure
• Thymoma
• Superior vena cava obstruction
• Pulmonary hematoma
• Pulmonary sequestration
• Bronchogenic cyst
• Pericardial effusion
• Mesothelioma
• Benign pleural fibroma
• Anomalous coronary artery
• Bicuspid aortic valve
• Ascending thoracic aortic aneurysm
• Myocarditis
• Hypertrophic cardiomyopathy
• ARVD
• Partial Anomalous pulmonary venous return
• Atrial septal defect
• Myocardial Infarction
117
Pulmonary and Cardiovascular Radiology: PGY5
CO -SUPERVISORS: Dr. Rick Bhatia, Health Sciences Centre
Dr. Scott Harris, Health Sciences Centre
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during
PGY5, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with
particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including
preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac
studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty
with resident on ultrasound duty).
Report consults
All duties listed above, with the caveat of self directed learning to focus on knowledge gaps and prepare for
exams. Exact goals and duties will be discussed with the resident at the start of the rotation.
* On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s
from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
118
Please note there is a graded responsibility within Pulmonary Radiology implying residents will
progress from having all their procedures closely supervised and all examination study reports
checked, to being able to perform procedures with little or no supervision and to report
independently.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
1. Medical Expert
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image
and clinical history.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of at least the following chest and cardiac conditions:
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
121
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
122
Emergency Radiology: PGY2
SUPERVISOR: Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the Emergency rotation during PGY2, incorporated
into CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
At the beginning of the rotation, the ER resident will inform the ER department of his/her responsibility to
help organize, coordinate, recommend and whenever possible report appropriate diagnostic imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner,
whether dealing with patients, colleagues, or health care workers.
The ER resident must review cross sectional exams with staff in a timely fashion, and in an urgent/emergent
fashion, should the patient’s condition (or ER physician) dictate the same.
A verbal report must be provided to the responsible ER physician for major findings that are detected; the
details of this communication must be then acknowledged subsequently at the end of the generated report
(i.e. time and date of verbal report and the physician’s name receiving the verbal report).
The ER resident will be responsible to prepare 2 ER cases, on Powerpoint (in an ICR format) from a
provided list, to the ER supervisor by the end of the rotation.
The resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where
applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so
can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
The ER Resident will review at least 20 ER PF day with the staff designated in the ER Plain Film category
contained in the Work Rota. When there is no staff designated in this slot, then the review can occur with the
staff designated in the standard Plain Film slot.
The ER resident will review the ER renal colic CT exams ordered the evening before, but performed the
morning after, with the designated CT body staff for that day.
123
Whenever possible, the ER resident is responsible to report any cross sectional studies that have been
performed on patients from the ER, with the designated staff for that day (i.e. ER renal US with the
radiologist covering US that day).
Please note: The books needed will be provided from Dr. Jeon at the beginning of the rotation and must be
returned on the final day of the rotation.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Emergency Radiology: Case Review Series -Stuart E. Mirvis MD FACR (Author), Kathirkamanathan
Shanmuganathan MD (Author), Lisa A. Miller MD (Author), Clint W. Sliker MD (Author)
Emergency Radiology: The Requisites (Requisites in Radiology)-Jorge A Soto MD (Author), Brian Lucey MD
(Author)
Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, Fourth
Edition, 2000
.
Harris JH, Mirvis SE. The Radiology of Acute Cervical Spine Trauma. Williams and Wilkins, Baltimore, MD,
Third Edition, 1995.
Mirvis SE, Young JWR. Imaging in Trauma and Acute Care. Williams and Wilkins, Baltimore, MD, 1992.
Novelline RA. Advances in Emergency Radiology, Volumes I and II, Radiological Clinics of North America.
WB Saunders, Philadelphia, PA, 1999.
West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency and Trauma Radiology.
American Roentgen Ray Society, 2000
1. Medical Expert
1. Identify and describe the basic PF/CT/US anatomy (where applicable) of the CNS, Respiratory,
Cardiovascular, Abdominal/Pelvic (including GI, GU and OB/Gyne), and MSK systems.
2. Discuss the ER radiology Curriculum after studying the accompanying ER Core Curriculum and
content structure/suggested readings: ( see appendix 1)
A Central Nervous System - 3
B. Face and Neck -5
C. Spine: -7
D. Chest - 8
E. Cardiovascular -10
124
F. Abdomen -12
G. Gynecological and Obstetrical - 14
H. Male Genitourinary -16
I. Upper Extremity -17
J. Pelvis and Hip -19
K. Lower extremity -21
3. Develop and master a systematic approach to the interpretation of plain radiographs of the spine,
chest and abdomen.
4. Discuss in detail the various CT/US imaging protocols used in the ER rotation.
5. Distinguish abnormal from normal findings on PF( where applicable)/ CT images of the brain,
head/neck and spine regions and to recognize the major disease processes that occur in these areas
particularly in the following areas :
a. Extra-axial hemorrhage
i. Subdural hematoma
ii. Epidural hematoma
b. Parenchymal Injuries
i. Cortical Contusion/traumatic hemorrhage
ii. Diffuse Axonal Injury
iii. Brainstem Injury
c. Non-traumatic Hemorrhage
i. Subarachnoid Hemorrhage
ii. Parenchymal Hemorrhage
d. Herniation Syndromes
e. Cerebral Infarction
f. CNS Infections
g. Spinal trauma
h. Facial Fractures
i. Acute Infections of the Sinuses and Neck
6. Distinguish abnormal from normal findings on PF/US/CT ( where applicable) images of the chest,
and to recognize the major disease processes that occur in these areas particularly in the following
areas :
a. Aorta
i. Trauma
ii. Dissection
iii. Aneurysm
b. Pulmonary Edema
c. Thrombo-embolic Disease
i. Pulmonary Embolism
ii. Deep Vein Thrombosis
d. Pericardial Effusion/Tamponade
e. Pneumothorax/Pneumomediastinum
7. Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the abdomen
and pelvis and to recognize the major disease processes that occur in these areas particularly in the
following areas:
a. Abdominal Trauma:
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i. Solid/Hollow Visceral Injuries
ii. Hemoperitoneum/Intraperitoneal Fluid
iii. Intraperitoneal /Retroperitoneal Hemorrhage
iv. Gas Collections –intraluminal and extraluminal
v. Bowel and Mesenteric Injuries
vi. Abdominal Wall and Diaphragmatic Injuries
iii. Pancreatitis
iv. GI Tract
• Bowel Obstruction
• Bowel Infarction
• Bowel Infection
o Appendicitis
o Diverticulitis
o Infectious Enteritis/Colitis
• Inflammatory Bowel Disease
o Crohn
o Ulcerative Colitis
• Epiploic Appendagitis/Omental Infarction
v. GU
• Urinary Tract Calculi
• Infection
o Renal Abscess
o Pyelonephritis
8. Distinguish abnormal from normal findings on Gynecologic Imaging of the pelvis and to recognize the
major disease processes that occur in these areas particularly in the following areas:
a. Ovarian Torsion
b. Ovarian Cystic Disease
c. Pelvic Inflammatory Disease
d. Endometritis
e. Subchorionic Hemorrhage
f. Spontaneous Abortion/Fetal Demise
g. Ectopic Pregnancy
9. Distinguish abnormal from normal findings in imaging the male GU system and to recognize the male
GU emergencies that occur in these areas particularly in the following areas:
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a. Traumatic
i. Urethral/Penile
ii. Scrotal/Testicular
b. Acute Non-traumatic Scrotal Conditions
i. Testicular Torsion
ii. Epidydimitis
iii. Orchitis
iv. Infarction
v. Acute Scrotal Fluid Collections
• Hydrocele
• Pyocele
• Hematocele
vi. Testicular Abscess
vii. Fournier’s Gangrene
10. Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the MSK
system and to recognize the major disease processes that occur in these areas particularly in the
following areas:
a. Upper Extremity
i. Scapular/Clavicular fractures
ii. Shoulder/Elbow Dislocations
iii. Forearm fractures /dislocations
iv. Metacarpal/Carpal fractures/dislocations
b. Pelvis and Hip
i. Pelvic Ring Fractures
ii. Isolated Pelvic Fractures
iii. Acetabular Fractures
iv. Hip fractures/disloctions
v. Femoral Fractures
vi. Septic Arthritis
vii. AVN
c. Lower Extremity
i. Tibial Fractures
1. Plateau
2. Plafond
ii. Ankle Injuries
iii. Patellar Injuries
iv. Knee Dislocations
v. Talar/Subtalar Fracture/Dislocation
vi. Tarso-metatarsal dislocation ( Lis Franc)
vii. Metatarsal Fracture/Dislocation
viii. Septic Arthritis
11. Develop a systematic approach in the CT evaluation of a patient involved in multi trauma.
12. Gain knowledge of anatomy and pathology related to organ systems commonly involved in trauma
including the brain, spine, chest, abdomen and pelvis, cardiovascular and musculoskeletal system. (
See objectives for specific topics)
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13. Have film reading ability of plain film examinations from the Emergency Room as well as Ultrasound
and CT examinations ordered through the Emergency Room.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
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Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
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Gastrointestinal – Abdominal Imaging: PGY2 & PGY5
SUPERVISOR: Dr. Dianne Colbert, Health Sciences Center
SUPERVISOR: Dr. Geoff Higgins, St. Clare’s
The following is an outline of the goals and objectives of the Gastrointestinal and Abdominal Imaging
rotation during PGY2 and PGY5, incorporated into CanMEDS format. These roles will be assessed and
remain consistent throughout the rotations as a PGY2 and PGY5, with the expectation that skills will be
further developed as a PGY5.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained at each stage of training will be given during the last week. The
examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The
inability to pass the exam could render the rotation incomplete, and the rotation will be completed at
a later date.
Residents are required to perform 5 screening lists per week and to perform all GI specific procedures.
The resident may be asked to perform other fluoroscopic studies when there is no other resident assigned to that
specific procedure rotation.RST 4-WEEK ROTATI2 (OR SECOND 4-WEEK ROTION)
Outline and discuss the different imaging modalities available and their appropriate indications in the
comprehensive evaluation of the abdomen.
1. Peritoneal fluid
2. Pneumoperitoneum
3. Abdominal calcifications
Acquire a sound knowledge base in and accurately recognize, describe, and discuss the following:
1. Acute Abdomen
2. Small Bowel Obstruction
3. Large Bowel Obstruction
4. Bowel Ischemia and Infarction Abdominal Trauma
5. Lymphadenopathy
6. Abdominopelvic Tumors and Masses
7. AIDS in the Abdomen R ONE
4-WEK ROTATI2 (OR SECOND 4-WEEK ROTATION)
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1. Medical Expert
Perform, interpret and report upper and lower GI studies including small bowel studies.
Become competent in the interpretation and technical aspects with a focus of attention on plain film
examinations and contrast studies. ONE
Know the indications, limitations and complications and be able to perform, interpret, and report the
following studies:
Know the indications and be able to interpret and report an abdominal series.
Know the anatomy and function of the GI tract from the mouth to the anus.
Be able to recognize and give the differential diagnosis of at least the following:
• Pneumoperitoneum, pneumoretroperitoneum
• Gas in the biliary tree, portal venous system and pneumotosis intestinalis
• Ascites
• Abdominal mass
• Abdominal calcification
• Esophageal, gastric, small and large bowel obstruction
• Ileus
• Mucosal thickening (i.e., “thumbprinting”)
• Strictures
• Fistulas and sinus tracts
• Abnormalities as seen on contrast studies outlined in Objectives #1 and #2
Know the radiology, pathology, and clinical aspects including presentation, manifestations and
management of the following:
Know and recognize the surgical procedures commonly performed on the GI tract, for example:
• Bilroth I and II
• Roux-en –Y
• Whipple’s procedure
• Esophagectomy with gastric pull through
• Hemi and total colectomy, A-P resection
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information. Handle conflict situations well.
Produce succinct reports that describe findings, most likely diagnosis and, where appropriate,
recommend further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
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Understand the fundamentals of quality assurance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design.
See as many cases as possible during the days with follow-up reading performed at night.
Residents will be required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of
care and maintain appropriate professional behaviour.
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Genitourinary Radiology: PGY2
SUPERVISOR: Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the GU rotation during PGY2, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
At the beginning of the rotation, the GU resident will inform the CR, US and CT departments of his/her
responsibility to help organize, coordinate, recommend and whenever possible report appropriate diagnostic
imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner,
whether dealing with patients, colleagues, or health care workers.
The GU resident must review cross sectional exams with staff in a timely fashion, and in an urgent/emergent
fashion, should the patient’s condition (or attending physician) dictate the same.
A verbal report must be provided to the responsible attending physician for major findings that are detected;
the details of this communication must be then acknowledged subsequently at the end of the generated
report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).
The GU resident will present cases to staff in a prepared, organized fashion and subsequently dictate a
timely concise, accurate report.
The GU resident will be responsible to prepare 2 GU cases, on Powerpoint (in an ICR format) from a
provided list, to the GU supervisor by the end of the rotation.
The resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where
applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident
doing so can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
The GU Resident will review at least 10 Abdominal/KUB PF day with the staff designated in either of
the ER PF, US or CT categories contained in the Work Rota. When there is no staff designated in the
ER PF slot, then the review can occur with the staff designated in the standard Plain Film slot.
The GU resident will review the ER renal colic CT exams ordered the evening before ( or co-share
with the ER Radiology resident on for the same month), but performed the morning after, with the
designated CT body staff for that day.
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Whenever possible, the GU resident is responsible to report all GU cross sectional studies (with the
exception of MR) that have been performed on patients, with the designated staff for that day (i.e.
Renal US with the radiologist covering US that day).
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Dunnick, N.R., Sandler, C.M., Newhouse, J.N., Amis, Jr., E.S., Textbook of Uroradiology, 4th ed.,
Philadelphia, PA: Lippincott Williams & Wilkins, 2008.
Zagoria, R.J. Genitourinary Radiology, 2nd edition -- Case Review Series -The Requisites, Mosby, St.
Louis, MO: Mosby, 2004.
Diagnostic Ultrasound: 2-Volume Set. Editors: Carol Rumack (Author), Stephanie Wilson , J. William
Charboneau, Jo-Ann Johnson.
1. Medical Expert
Identify and describe the basic PF/CT/US male/female anatomy (where applicable) of the GU
system.
Discuss the GU radiology curriculum after studying the accompanying GU Core Curriculum and
content structure/suggested readings: (see app. 1)
a) Understand the physical properties of iodinated contrast media and the physiologic
mechanisms of contrast media excretion.
b) Learn to screen patients who are at risk from injection of intravascular radiographic contrast
material. Understand the classification, symptoms, and signs of contrast reactions and clinical
management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
ii) Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
c) Understand the indications for premedication and the appropriate regimen to premedicate
contrast sensitive patients including dosages, and dose scheduling
a) Plain abdominal films for bowel gas pattern and recognition of masses/calcification
i) The Bosniak Classification for evaluating renal cystic masses and implications for
management of complex renal cysts.
ii) The imaging and staging of the GU organs including renal, urothelial, prostate,
endometrial, cervical, and ovarian cancers.
iii) The multi-cystic renal diseases including genetic syndromes such as autosomal
dominant adult polycystic kidney disease and VHL.
Learn conventional imaging protocols of the urinary tract e.g. IVP, RU, VCUG, retrograde
urethrography (RUG), and hysterosalpingography (HSG).
b) Routine views and additional films required to achieve the tailored urogram:
Recognize a large variety of congenital abnormalities of the GU/Gyne tract especially the more
common such as:
a. Fusion abnormalities
i. - horseshoe kidney
ii. crossed fused ectopia
iii. ectopic kidney
b. Partial and complete duplications of the collecting systems
c. Renal tubular ectasia ( medullary sponge kidney)
d. Renal Agenesis
e. Hutch Diverticula
f. Uterine Malformations including:
i. Septate
ii. Bicornuate
iii. Uterus Didelphys
Distinguish abnormal from normal findings on Gynecologic Imaging of the pelvis and to recognize the
major disease processes that occur in these areas particularly in the following areas:
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g. Ovarian Torsion
h. Ovarian Cystic Disease
i. Pelvic Inflammatory Disease
j. Endometritis
k. Subchorionic Hemorrhage
l. Spontaneous Abortion/Fetal Demise
m. Ectopic Pregnancy
n. Ovarian, cervical and endometrial cancer
o. Benign disease of the uterus including leiomyoma, endometriosis and adenomyosis
Distinguish abnormal from normal findings in imaging the male/female GU systems and to recognize
the GU emergencies that occur in these areas particularly in the following areas:
p. Trauma
i. Renal/Bladder
ii. Urethral/Penile
iii. Scrotal/Testicular
iv. Vaginal
q. Acute Non-traumatic Scrotal Conditions
i. Testicular Torsion
ii. Epidydimitis
iii. Orchitis
iv. Infarction
v. Acute Scrotal Fluid Collections
• Hydrocele
• Pyocele
• Hematocele
vi. Testicular Abscess
vii. Fournier’s Gangrene
Understand the importance of the timing of scans for dedicated contrast enhanced CT and MR
imaging of the kidneys to include the corticomedullary, nephrographic and excretory phases.
Initiate, organize, screen and triage the various diagnostic imaging requests that are generated by
the ordering GU clinicians.
Displays basic knowledge regarding the approximate doses acquired by common GU procedures.
(see appendix on Contrast media).
Understands the risks and contra-indications to the use of Gadolinium based MR contrast media (
see appendix)
Develop lifelong learning skills to augment knowledge of medicine and Diagnostic Radiology
(recognition of imaging abnormalities with synthesis of clinical and radiological information to arrive
at the correct diagnosis or differential diagnosis)
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Knowledge of principles of Radiation Physics and Dosimetry (including radiation dose for key
imaging exams)
Ability to use all relevant Resource Materials (Refer to Appendix - Core Reference List of texts,
references, websites, sources for lifelong self-learning)
Knowledge of how the different imaging modalities produce diagnostic information and their
advantages and limitations.
Have film reading ability of plain film (KUB) examinations as well as GU Ultrasound and CT
examinations ordered through the Emergency Room as well as routine exams.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
Skills:
a) Provide an accurate clear and informative radiologic report with a precise diagnosis when possible
or a relevant differential diagnosis with recommendations for follow up or further imaging as
appropriate
b) Directly communicate urgent and unexpected findings with the referring physician or their
representative. Document the communication in the report.
c) Demonstrate effective face to face skills with patients and their families, other physicians, nurses,
technologists and support staff
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
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Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Skills:
b) Gather information from the patient folder, faculty, literature, digital textbooks and internet
c) Develop an imaging plan based on the clinical presentation and available information
e) Demonstrate awareness of impact of ionizing radiation in pregnancy, on germ cells, and for
possible carcinogenesis and demonstrate knowledge of measures to minimize patient exposure
f) Knowledge of alternative imaging modalities, not utilizing ionizing radiation, and their application in
select circumstances
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
Identify strengths, deficiencies, and limits in their knowledge and expertise; set learning and
improvement goals; use multiple sources, including information technology to optimize life-long
learning and support patient care decisions.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate knowledge of issues of impairment (i.e. physical, mental and alcohol and substance
abuse) obligations for impaired physician reporting, and resources and options for care of self-
impairment or impaired colleagues.
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Mammography: PGY3, PGY4 & PGY5
SUPERVISOR: Dr. Nancy Wadden, St. Clare’s
The following is an outline of the goals and objectives of the Mammography rotation during residency,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam could render the rotation incomplete, and
the rotation will be completed at a later date.
Residents will be required to interpret mammographic studies as well as perform needle localization and
core biopsy procedures under the supervision of a supervising staff radiologist.
At the end of the final Breast Imaging Rotation, the resident shall be able to adequately address the
following topics. With each rotation leading up to the final rotation, the resident will progress through these
topics.
6. Recommendation for screening, evidence from RCT, lead time bias, sojourn time, etc.
9. Physics:
- focal spot, film/screen, digital, effect and benefit of compression, grids, magnification,
radiation dose, etc.
10. MR physics.
11. Artifacts.
12. Mammographic positioning – MLO, CC, ML, LM, cleavage, exaggerated CC, change of angle
views, rolled views, etc.
13. Triangulation.
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15. Masses – BiRads description.
a. Cyst
b. Fibroadenoma
c. Fat necrosis
d. Galactocele
e. Hamartoma
f. Lymph nodes – benign and malignant
g. Fibrosis
h. Hematoma/contusion
i. Lymphoma
j. Phyllodes tumor
k. Malignancy
a. Approach to follow-up
b. Post surgical scar
c. Radiation changes – acute/subacute/chronic
Understand the role of screening mammography and its limitations and applications.
Perform ultrasound and mammographic guided localization, aspirations and core biopsies.
Know the anatomy of the female breast including lymphatic drainage routes and physiologic changes
which occur with age.
Know the anatomy of the male breast and how it differs from the female breast.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information while handling conflict situations well.
Produce succinct reports that describe findings, most likely diagnosis and where appropriate
recommends further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
143
develop these skills. In addition residents will be required to be active participants in inter and intra
discipline rounds.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgement.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (mammography, lung cancer, colon cancer, cardiac
calcification and total body).
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design with respect to Radiology.
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The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long
term plan. For a resident, this would include seeing as many cases as possible during the days with
follow-up reading performed at night.
7. Professional
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of
care and appropriate professional behaviour.
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MRI: PGY3 & PGY5
SUPERVISOR: Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the MRI rotation during PGY 3 and 5, incorporated
into CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam could render the rotation incomplete, and the rotation will be
completed at a later date.
At the beginning of the rotation, the MR resident will inform the MR operating staff at the Janeway and HSC
of his/her daily responsibility to help initiate, organize, protocol and report appropriate MR imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner,
whether dealing with patients, colleagues, or health care workers.
The MR resident must review all MR abdominal exams with attending staff in a timely fashion, and in an
urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same. The junior
MR resident is responsible only for the abdominal MR exams during his/her month.
The senior MR resident should review selected MR MSK exams with attending staff in a timely fashion, and
in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same.
The senior MR resident may review selected MR CNS exams with attending staff in a timely fashion, and in
an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same.
The MR resident will be responsible to prepare 2 MR cases, on PowerPoint (in ICR format) from a provided
list, to the MR supervisor by the end of the rotation.
The MR resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where
applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so
can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
Any holiday time taken during this rotation must have appropriate approval and follow the protocol outlined
in the Radiology Resident Manual.
The MR Resident will review at least 10 (total number) of Abdominal and/or MSK PF per day with the staff
designated in either of the ER PF or MR slots contained in the Work Rota. When there is no staff designated
in the ER PF slot, then the review can occur with the staff designated in the standard Plain Film slot.
146
The MR resident will check the daily MR patient list at both sites (Janeway and HSC) to ensure proper
protocols are in place and to deal with any safety/contrast questions that may arise.
The MR resident will present cases to staff in a prepared, organized fashion and subsequently dictate a
timely concise, accurate report.
A verbal report must be provided to the responsible attending physician for urgent findings that are detected;
the details of this communication must be then acknowledged subsequently at the end of the generated
report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).
It is recommended that a junior resident read at least two hours a night whereas a senior resident should
plan to read four to six hours per night.
Resource List :
1. Medical Expert
OBJECTIVES PGY 3 :
1. Identify and describe the basic MR anatomy of the abdomen/pelvis, Musculoskeletal and CNS
systems.
4. Determine indications for appropriate MR examinations in relation to the specific organ system, after
reviewing pertinent background clinical information, and preceding diagnostic examinations.
5. Outline and discuss current MR imaging procedures/protocols after studying the accompanying MR
Protocol Document and content structure/suggested readings:
6. Outline and discuss indications and contraindications of Gadolinium contrast agents as well as the
following:
147
a) Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast
media excretion.
b) Identify patients who are at risk from injection of intravascular radiographic contrast material.
Comprehend the classification, symptoms, and signs of contrast reactions and clinical
management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
ii) Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
c) Understand the indications for premedication and the appropriate regimen to premedicate
contrast sensitive patients including dosages, and dose scheduling
7. Describe the major elements in the MR organ based medical knowledge objectives (curriculum)
specifically in the Abdominal, MSK and CNS systems.
8. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
9. Effectively communicate simple instructions to technologists and significant findings to the referring
physician staff and house staff.
10. Organize MR diagnostic imaging requests that are generated by the ordering clinicians.
OBJECTIVES PGY 5 :
14. Determine indications for, and implement appropriate MR examinations in relation to the specific
organ system, after reviewing pertinent background clinical information, and preceding diagnostic
examinations.
15. Outline and discuss and implement current MR imaging procedures/protocols after studying the
accompanying MR Protocol Document and content structure/suggested readings:
16. Demonstrate a sound understanding of the indications and contraindications of Gadolinium contrast
agents as well as the following:
a) Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast
media excretion.
b) Identify patients who are at risk from injection of intravascular radiographic contrast material.
Comprehend the classification, symptoms, and signs of contrast reactions and clinical
management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
148
i) Consult the ACR Manual for Contrast Media.
ii) Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
c) Understand the indications for premedication and the appropriate regimen to premedicate
contrast sensitive patients including dosages, and dose scheduling
17. Describe the major elements in the MR organ based medical knowledge objectives (curriculum)
specifically in the Abdominal, MSK and CNS systems.
18. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
19. Effectively communicate instructions to technologists and significant findings to the referring
physician staff and house staff.
20. Initiate, organize/coordinate and screen/triage MR diagnostic imaging requests that are generated by
ordering clinicians.
a) Develop lifelong learning skills to augment knowledge of medicine and Diagnostic Radiology
(recognition of imaging abnormalities with synthesis of clinical and radiological information to
arrive at the correct diagnosis or differential diagnosis)
d) Demonstrate the ability to use all relevant Resource Materials (Refer to Appendix - Core
Reference List of texts, references, websites, sources for lifelong self-learning)
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
Skills:
149
a) Provide an accurate clear and informative radiologic report with a precise diagnosis when
possible or a relevant differential diagnosis with recommendations for follow up or further
imaging as appropriate
b) Directly communicate urgent and unexpected findings with the referring physician or their
representative. Document the communication in the report.
c) Demonstrate effective face to face skills with patients and their families, other physicians,
nurses, technologists and support staff
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
150
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Skills:
b) Gather information from the patient folder, faculty, literature, digital textbooks and internet
c) Develop an imaging plan based on the clinical presentation and available information
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
Identify strengths, deficiencies, and limits in their knowledge and expertise; set learning and
improvement goals; use multiple sources, including information technology to optimize life-long
learning and support patient care decisions.
151
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
Demonstrate knowledge of issues of impairment (i.e. physical, mental and alcohol and substance
abuse) obligations for impaired physician reporting, and resources and options for care of self-
impairment or impaired colleagues.
152
Musculoskeletal Radiology (HSC): Level I
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS
Objectives follow the HSC MSK Objectives in Level II below)
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY2,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-
in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the
rotation incomplete, and the rotation will be completed at a later date.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies with an emphasis on plain
radiographs.
1. The minimum number of plain radiographs is 30 per day. A list of all Plain Radiographs, MR and CT
exam accession numbers of reported exams is to be submitted to Karen on a weekly basis – please
discuss an appropriate day with Karen.
2. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday &
15-20 studies on Tuesday).
3. All MSK CT exams for the week (average 1-2 per day).
Actively participate and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon,
but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit)
and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by
153
the end of the rotation.
Observe and understand Basic Radiographic Positioning: Radiography & MRI: approximately 2 Days will be
assigned with technologist.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility
of resident until their return at end of rotation.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Recognize and describe fractures and dislocations of the cervical, thoracic and lumbar spine.
Recognize and evaluate imaging studies which demonstrate arthopathies including: rheumatoid
arthritis, psoriatic arthritis, crystalline arthropathies, osteoarthritis, sero-negative
spondyloarthropathies, scleroderma as well as other connective tissue diseases, vasculitic conditions
including systemic lupus.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
• Multiple myeloma
• Metastatic disease
• Aneurysmal bone cyst
• Solitary bone cyst
• Enchondroma
• Ewing’s sarcoma
• Chordoma
• Pigmented villonodular synovitis
• Chondroblastoma
• Osteogenic sarcoma
• Fibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma
• Osteoblastoma
• Hemangiomas
• Osteochondroma (s)
• Nerve sheath tumors
• Adamantinoma
• Osteomyelitis
• Septic arthritis
• Cellulites
• Myositis
• Tenosynovitis
• Abscess Formation
• Discitis
• Gangrene
155
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on knee and shoulder).
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
knee and shoulder. The resident should have good understanding of at least the following:
• ACL tear
• Meniscal injury
• MCL tear
• Lateral complex injury
• Postero-lateral corner injury
• Quadriceps/patellar tendon tear
• OCD
• Rotator cuff tear
• Shoulder labral tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
• Lytic/radiolucent bony lesion (s)
• Sclerotic bony lesion (s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
• Soft tissue calcification
• Soft tissue mass
156
Musculoskeletal Radiology (HSC): Level II
SUPERVISOR: Dr. John Hopkins, Health Sciences
The following is an outline of both the curriculum as well as the goals and objectives of the Musculoskeletal
rotation during PGY 4, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-
in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the
rotation incomplete, and the rotation will be completed at a later date.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies.
4. The minimum number of plain radiographs is 40 per day. A list of all exam accession numbers of
reported exams is to be submitted to Karen on a weekly basis.
5. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday &
15-20 studies on Tuesday).
6. All MSK CT exams for the week (average 1-2 per day).
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Perform with formal guidance and gain increased understanding and proficiency in MSK interventional
procedures such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for
Tuesday afternoon, but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday
(Room 10, MR Unit) and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by
the end of the rotation.
157
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first
rotation.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility
of resident until their return at end of rotation.
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Review and consolidate knowledge of normal MRI anatomy of the knee and shoulder.
Demonstrate learning of normal MRI anatomy of the hip and wrist.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar
spine.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
158
Demonstrate learning of a systematic approach to arthritis. Be able to describe and differentiate
salient radiologic (radiographic, CT and MR) features of common arthropathies including
osteoarthritis, inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-
negative spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition,
gout, hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus
erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, and synovial
chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive & non-aggressive lesions and be able to recognize them on imaging
studies. Should know radiology, pathology, presentation and management of at least the following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
• Multiple myeloma
• Metastatic disease
• Aneurysmal bone cyst
• Solitary bone cyst
• Enchondroma
• Ewing’s sarcoma
• Chordoma
• Pigmented villonodular synovitis
• Chondroblastoma
• Osteogenic sarcoma
• Fibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma
• Osteoblastoma
• Hemangiomas
• Osteochondroma (s)
• Nerve sheath tumors
• Adamantinoma
159
• Discitis
• Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on hip and wrist)
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
hip and wrist. The resident should have good understanding of at least the following:
• ACL tear
• Meniscal injury
• MCL tear
• Lateral complex injury
• Postero-lateral corner injury
• Quadriceps/patellar tendon tear
• Knee OCD
• Rotator cuff tear
• Biceps tendon rupture (proximal and distal)
• Shoulder and hip labral tear
• Hip AVN
• Transient osteoporosis
• Hip Fracture
• Femoroacetabular Impingement
• Kienbock’s
• TFCC Tear
• Tenosynovitis
• Scapholunate/lunotriquetral ligament tear
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
160
• Lytic/radiolucent bony lesion (s)
• Sclerotic bony lesion (s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
• Soft tissue calcification
• Soft tissue mass
2. Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3. Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
162
Musculoskeletal Radiology (HSC): Level III
SUPERVISOR: Dr. John Hopkins, Health Sciences
The following is an outline of both the curriculum as well as the goals and objectives of the Musculoskeletal
rotation during PGY 5, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-
in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the
rotation incomplete, and the rotation will be completed at a later date.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies.
1. The minimum number of plain radiographs is 50 per day. A list of exam accession numbers of reported
exams is to be submitted to Karen/Margie at end of each day.
2. All adult MR examinations for the week from both HSC and Janeway sites (4-6 studies on Monday &
15-20 studies on Tuesday).
3. All MSK CT exams for the week (average 1-2 per day).
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Perform independently and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy. Arthrograms are usually scheduled for Tuesday afternoon,
but biopsies are random days. It is your duty to check the fluoroscopy list each Tuesday (Room 10, MR Unit)
and biopsy list each day (Nursing Station).
Review MR protocols for your MR list each day for Monday & Tuesday.
Submit to Dr. Hopkins (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by
the end of the rotation.
163
Present 1 MSK case each Tuesday at ICR during your rotation.
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first and
second rotations.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Textbooks will be provided; assigned to resident at beginning of rotation and are the responsibility
of resident until their return at end of rotation.
14. Musculoskeletal MRI: Chapters Elbow, Ankle & Foot & Review Shoulder, Knee
15. The Requisites: Musculoskeletal Imaging: Chapters 38, 42-47
16. Research Assigned Topics & Cases: Resnick & related journal articles
1. Medical Expert
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
Review and consolidate knowledge of normal MRI anatomy of the knee, shoulder, hip and wrist.
Demonstrate learning of normal MRI anatomy of the elbow, ankle and foot.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar
spine.
164
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
• Multiple myeloma
• Metastatic disease
• Aneurysmal bone cyst
• Solitary bone cyst
• Enchondroma
• Ewing’s sarcoma
• Chordoma
• Pigmented villonodular synovitis
• Chondroblastoma
• Osteogenic sarcoma
• Fibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma
• Osteoblastoma
• Hemangiomas
• Osteochondroma (s)
• Nerve sheath tumors
• Adamantinoma
• Osteomyelitis
165
• Septic arthritis
• Cellulitis
• Myositis
• Tenosynovitis
• Abscess Formation
• Discitis
• Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Recognize radiologic findings of hematopoietic and storage diseases including sickle cell anemia,
thalassemia, mastocytosis, and Gaucher’s disease.
Demonstrate systematic approach to relatively common dysplasias and congenital conditions such
as achondroplasia, osteogenesis imperfecta, osteopetrosis
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on elbow, ankle and foot)
Recognize and describe imaging features of internal derangements of joints with emphasis upon
elbow, ankle and foot, and thorough review of knee, shoulder, hip and wrist. The resident should
have good understanding of at least the following:
• ACL tear
• Meniscal injury
• MCL tear
• Lateral complex injury
• Postero-lateral corner injury
• Quadriceps/patellar tendon tear
166
• Knee OCD
• Rotator cuff tear
• Biceps tendon rupture (proximal and distal)
• Shoulder and hip labral tear
• Hip AVN
• Transient Osteoporosis
• Hip fracture
• Femoroacetabular impingement
• Transient osteoporosis
• Kienbock’s
• TFCC Tear
• Tenosynovitis
• Scapholunate/lunotriquetral ligament tear
• Achilles tendon rupture
• Medial, lateral and anterior ankle tendon injury
• Ankle ligament tears
• Tarsal tunnel syndrome
• Sinus tarsi syndrome
• Tarsal/carpal coalition
• Talar OCD/osteochondral injury and AVN
• Morton’s neuroma
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
• Lytic/radiolucent bony lesion (s)
• Sclerotic bony lesion (s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
• Soft tissue calcification
• Soft tissue mass
2. Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
167
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
168
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
169
Musculoskeletal Radiology (SCM): Level I
SUPERVISOR: Dr. Eric Pike, St. Clare’s
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY2,
incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience and
would appreciate that any problems arising prior to, during or after your rotation be brought directly to my
attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula will be given
within the last week and will assess the acquisition of knowledge throughout the rotation. The exam
questions are derived from the rotation objectives, and consist of fill-in-the-blank and OSCE type format. A
pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be
completed at a later date.
The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and
procedures related to the musculoskeletal system. During each 4 week rotation the resident should:
1. Concentrate first and foremost on seeing as many plain radiographs related to MSK imaging. This
should include daily films from the Emergency Department, Orthopedic Clinics and Out Patient
areas.
2. Check each day for interventional procedures that are booked including arthrograms and biopsies,
as well as joint injections and aspirations.
3. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases
performed using these modalities should be forwarded to you. Effort should be made to be present
for ultrasound studies particularly involving the shoulder and other tendons.
4. Review MRI cases performed under St. Clare’s. These studies are generally performed on
Wednesday evening and during the day/evening on Thursday. The resident can coordinate when the
cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if
desired but this is not mandatory. The Junior Resident should concentrate on the common exams of
the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload
for the week can be up to 25 cases.
5. At the end of your rotation, we are going to be administering a short oral exam of approximately 10
cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching
sessions on various MSK topics.
You are required to learn the anatomy, physiology and associated pathological conditions affecting the
musculoskeletal system and to be able to interpret and report associated imaging studies with an emphasis
on plain radiographs.
1. The minimum number of plain radiographs is 30 per day. A list of exam accession numbers of
reported exams is to be submitted to Karen weekly – please discuss an appropriate day with Karen.
2. All adult MR examinations for the week performed on Wednesday, Thursday and Friday.
3. All MSK CT exams for the week (average 1-2 per day).
170
4. All risk Ultrasound exams (average 10 – 15 per week)
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Actively participate and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the
end of the rotation.
Observe and understand Basic Radiographic Positioning: Radiography & MRI: approximately 2 Days will be
assigned with technologist.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
Textbooks will be provided; assigned to the resident at the beginning of rotation and are the
responsibility of the resident until their return at the end of the rotation.
1. Medical Expert
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Recognize and describe fractures and dislocations of the cervical, thoracic and lumbar spine.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Recognize and evaluate imaging studies which demonstrate arthopathies including: rheumatoid
arthritis, psoriatic arthritis, crystalline arthropathies, osteoarthritis, sero-negative
spondyloarthropathies, scleroderma as well as other connective tissue diseases, vasculitic conditions
including systemic lupus.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
• Multiple myeloma
• Metastatic disease
• Aneurysmal bone cyst
• Solitary bone cyst
• Enchondroma
172
• Ewing’s sarcoma
• Chordoma
• Pigmented villonodular synovitis
• Chondroblastoma
• Chondrosarcoma
• Osteogenic sarcoma
• Fibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma
• Osteoblastoma
• Hemangiomas
• Osteochondroma (s)
• Nerve sheath tumors
• Adamantinoma
• Osteomyelitis
• Septic arthritis
• Cellulitis
• Myositis
• Tenosynovitis
• Abscess Formation
• Discitis
• Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on knee and shoulder).
173
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
knee and shoulder. The resident should have good understanding of at least the following:
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
• Lytic/radiolucent bony lesion(s)
• Sclerotic bony lesion(s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
• Soft tissue calcification
• Soft tissue mass
2. Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3. Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
174
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
176
Musculoskeletal Radiology: Level II
SUPERVISOR: Dr. Eric Pike, St. Clare’s
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY 4,
incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience. I
would appreciate that any problems arising prior to, during or after your rotation be brought directly to my
attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula will be given
within the last week and will assess the acquisition of knowledge throughout the rotation. The exam
questions are derived from the rotation objectives, and consist of fill-in-the-blank, and OSCE type format. A
pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be
completed at a later date.
The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and
procedures related to the musculoskeletal system. During each 4 week rotation the resident should:
6. Concentrate first and foremost on seeing as many plain radiographs related to MSK imaging. This
should include daily films from the Emergency Department, Orthopedic Clinics and Out Patient
areas.
7. Check each day for interventional procedures that are booked including arthrograms, biopsies as
well as joint injections and aspirations.
8. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases
performed using these modalities should be forwarded to you. Effort should be made to be present
for ultrasound studies particularly involving the shoulder and other tendons.
9. Review MRI cases performed under St. Clare’s each week. These studies are generally performed
on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when
the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if
desired but this is not mandatory. The Junior Resident should concentrate on the common exams of
the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload
for the week can be up to 25 cases. The more experienced Senior Resident should take on a heavier
caseload.
10. At the end of your rotation, we are going to be administering a short oral exam of approximately 10
cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching
sessions on various MSK topics.
You are required to learn the anatomy, physiology and associated pathological conditions affecting the
musculoskeletal system and to be able to interpret and report associated imaging studies.
7. The minimum number of plain radiographs is 40 per day. A list of exam accession numbers of
177
reported exams is to be submitted to Karen weekly – please discuss an appropriate day with Karen.
8. All adult MR examinations for the week performed on Wednesday, Thursday and Friday.
9. All MSK CT exams for the week (average 1-2 per day).
10. All risk Ultrasound exams (average 10 – 15 per week)
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Perform with formal guidance and gain increased understanding and proficiency in MSK interventional
procedures such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the
end of the rotation.
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first
rotation.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Textbooks will be provided; assigned to the resident at beginning of the rotation and are the
responsibility of the resident until their return at the end of rotation.
1. Medical Expert
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system.
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular
skeleton.
Review and consolidate knowledge of normal MRI anatomy of the knee and shoulder.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition and description of fractures and dislocations of the cervical, thoracic and lumbar
spine.
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
179
Recognize and describe common locations of and radiologic manifestations of osteonecrosis.
Recognize features of MSK neoplasms including soft tissue and bone tumors. The resident should
know the features of aggressive and non-aggressive lesions and be able to recognize them on
imaging studies. Should know radiology, pathology, presentation and management of at least the
following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
• Multiple myeloma
• Metastatic disease
• Aneurysmal bone cyst
• Solitary bone cyst
• Enchondroma
• Ewing’s sarcoma
• Chordoma
• Pigmented villonodular synovitis
• Chondroblastoma
• Chondrosarcoma
• Osteogenic sarcoma
• Fibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma
• Osteoblastoma
• Hemangiomas
• Osteochondroma (s)
• Nerve sheath tumors
• Adamantinoma
• Osteomyelitis
• Septic arthritis
• Cellulitis
• Myositis
• Tenosynovitis
• Abscess Formation
• Discitis
• Gangrene
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
180
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on hip and wrist).
Recognize and describe imaging features of internal derangements of joints with an emphasis on the
hip and wrist. The resident should have good understanding of at least the following:
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
• Lytic/radiolucent bony lesion (s)
• Sclerotic bony lesion (s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
• Soft tissue calcification
• Soft tissue mass
2. Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
181
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3. Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
182
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
183
Musculoskeletal Radiology (SCM): Level III
SUPERVISOR: Dr. Eric Pike, St. Clare’s
The following is an outline of the goals and objectives of the Musculoskeletal rotation during PGY 5,
incorporated into CANMEDS format. I will make every effort to make your rotation a positive experience. I
would appreciate that any problems arising prior to, during or after your rotation be brought directly to my
attention first.
The assessment tools utilized during the rotation include global faculty ratings and the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. The exam questions are derived from the rotation objectives, and consist of fill-in-the-blank,
and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation
incomplete, and the rotation will be completed at a later date.
The musculoskeletal rotation at St. Clare’s Hospital Site offers exposure to all imaging modalities and
procedures related to the musculoskeletal system. During each 4 week rotation the resident should:
11. Concentrate first & foremost on seeing as many plain radiographs related to MSK imaging. This
should include daily films from the Emergency Department, Orthopedic Clinics & Out Patient areas.
12. Check each day for interventional procedures that are booked including arthrograms, biopsies as
well as joint injections and aspirations.
13. Coordinate with attending staff and technologists in CT and ultrasound areas that MSK cases
performed using these modalities should be forwarded to you. Effort should be made to be present
for ultrasound studies particularly involving the shoulder and other tendons.
14. Review MRI cases performed under St. Clare’s each week. These studies are generally performed
on Wednesday evening and during the day/evening on Thursday. The resident can coordinate when
the cases can be reviewed. On Friday evening spinal MRI’s are also done which can be reviewed if
desired but this is not mandatory. The Junior Resident should concentrate on the common exams of
the knee, hip and shoulder and not be concerned about trying to do all of the cases as the workload
for the week can be up to 25 cases. The more experienced Senior Resident should take on a heavier
caseload.
15. At the end of your rotation, we are going to be administering a short oral exam of approximately 10
cases as part of the evaluation for the rotation. During the rotation, I will try to do some teaching
sessions on various MSK topics.
To learn the anatomy, physiology and associated pathological conditions affecting the musculoskeletal
system and to be able to interpret and report associated imaging studies.
11. The minimum number of plain radiographs is 50 per day. A list of exam accession numbers of
reported exams is to be submitted to Karen weekly - please discuss an appropriate day with Karen.
12. All adult MR examinations for the week performed on Wednesday, Thursday and Friday.
13. All MSK CT exams for the week (average 1-2 per day).
14. All risk Ultrasound exams (average 10 – 15 per week)
184
Understand indications, contra-indications as well as advantages and disadvantages of various imaging
modalities in the investigation of MSK disorders.
Gain exposure to modalities such as ultrasound, CT scanning, MRI and Nuclear Medicine imaging as they
apply to the MSK system.
Perform independently and gain increased understanding and proficiency in MSK interventional procedures
such as arthrography, joint aspiration and biopsy.
Review MR protocols for your MR list each day for Wednesday, Thursday and Friday.
Submit to Dr. Pike (in powerpoint format) 10 researched & prepared MSK cases as assigned to you by the
end of the rotation.
Demonstrate learning of knowledge based objectives and mastery of technical objectives for the first and
second rotations.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
Textbooks will be provided; assigned to the resident at the beginning of the rotation and are the
responsibility of the resident until their return at the end of rotation.
43. Musculoskeletal MRI: Chapters Elbow, Ankle & Foot & Review Shoulder, Knee
44. The Requisites: Musculoskeletal Imaging: Chapters 38, 42-47
45. Research Assigned Topics & Cases: Resnick & related journal articles
46. Fundamentals of Skeletal Radiology, 3rd Edition, C.A. Helms, W.B. Saunders/Elsevier 2005
47. Imaging of the Musculoskeletal System (Expert Radiology) Pope TL et al Saunders/Elsevier
2009
48. Musculoskeletal MRI, Helms C.A., Major N.M., et al, Saunders/Elsevier, 2009, (2nd Edition)
49. Bone and Joint Imaging, 3rd Edition, D. Resnick, 2004
50. Orthopedic Radiology, A Practical Approach, A Greenspan, Lippincott, 4th Edition, 2004
51. MRI of the Musculoskeletal System, 5th Edition, Berquist, Lippincott W/W, 2006
185
52. Musculoskeletal Imaging: A Teaching File, F Chew, 2nd Edition, 2005
1. Medical Expert
Recognize and describe positioning and anatomy of standard radiographic examinations of the
musculoskeletal system
Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
Review and consolidate knowledge of normal MRI anatomy of the knee, shoulder, hip and wrist.
Demonstrate learning of normal MRI anatomy of the elbow, ankle and foot.
Recognize & accurately describe common fractures and dislocations of the appendicular skeleton,
and know potential complications associated with them.
Review recognition & description of fractures & dislocations of the cervical, thoracic & lumbar spine.
Demonstrate learning of radiographic presentation & evaluation of osteomyelitis and septic arthritis.
Recognize and describe complications of orthopedic devices including fracture fixation and spine and
arthroplasty hardware.
Demonstrate learning of a systematic approach to arthritis. Be able to describe & differentiate salient
radiologic (radiographic, CT and MR) features of common arthropathies including osteoarthritis,
inflammatory arthropathy (rheumatoid, psoriatic, reactive, juvenile chronic, ser-negative
spondyloarthropathies), crystal deposition diseases (calcium pyrophosphate deposition, gout,
hydroxyapatite deposition), neuropathic arthropathy, connective tissue disease (systemic lupus
erythematosis, scleroderma, dermatomyositis), pigmented villonodular synovitis, & synovial
chondromatosis
Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the
lesion as aggressive or nonaggressive. Develop an appropriate differential diagnosis based on
patient age, lesion location, and lesion characteristics (margin, matrix, periosteal reaction, soft tissue
extension). Demonstrate knowledge of systematic, safe and cost effective radiologic work-up of bone
lesions including biopsy approach and compartmental anatomy.
Recognize features of MSK neoplasms including soft tissue & bone tumors. The resident should
know the features of aggressive & non-aggressive lesions and be able to recognize them on imaging
studies. Should know radiology, pathology, presentation and management of at least the following:
• Fibrous dysplasia
• Eosinophilic granuloma
• Giant cell tumor
• Non ossifying fibroma
• Osteoid osteoma
186
• Multiple myeloma
• Metastatic disease
• Aneurysmal bone cyst
• Solitary bone cyst
• Enchondroma
• Ewing’s sarcoma
• Chordoma
• Pigmented villonodular synovitis
• Chondroblastoma
• Chondrosarcoma
• Osteogenic sarcoma
• Fibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma
• Osteoblastoma
• Hemangiomas
• Osteochondroma (s)
• Nerve sheath tumors
• Adamantinoma
Become proficient and show increased understanding in the interpretation of post operative imaging
studies especially related to orthopedic hardware. The resident should also recognize the
appearance of various types of hardware.
Know the physiology of bone formation and maintenance and be able to recognize abnormalities of
this on imaging studies.
Gain increased knowledge and understanding of various metabolic conditions affecting the MSK
system and be able to recognize their manifestations on imaging studies including:
• Renal osteodystrophy
• Rickets
• Scurvy
• Paget’s disease
• Avascular necrosis/infarct
• Neuropathic joint
• Osteoporosis
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
187
Recognize radiologic findings and describe pathophysiology of endocrine disease including
hyperparathyroidism, renal osteodystrophy, osteomalacia/rickets, hypophosphatasia,
shypophosphatemia.
Recognize radiologic findings of hematopoietic and storage diseases including sickle cell anemia,
thalassemia, mastocytosis, and Gaucher’s disease.
Demonstrate systematic approach to relatively common dysplasias and congenital conditions such
as achondroplasia, osteogenesis imperfecta, osteopetrosis
Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of
musculoskeletal disorders (emphasis on elbow, ankle and foot)
Recognize and describe imaging features of internal derangements of joints with emphasis upon
elbow, ankle and foot, and thorough review of knee, shoulder, hip and wrist. The resident should
have good understanding of at least the following:
• ACL tear and PLC tear
• Meniscal injury
• MCL tear
• Lateral complex injury
• Postero-lateral corner injury
• Quadriceps/patellar tendon tear
• Knee OCD
• Rotator cuff tear
• Biceps tendon rupture (proximal and distal)
• Shoulder and hip labral tear plus variants (spectrum of labral injury)
• Hip AVN
• Transient Osteoporosis
• Hip fracture
• Femoroacetabular impingement
• Transient osteoporosis
• Kienbock’s
• TFCC Tear
• Tenosynovitis
• Scapholunate/lunotriquetral ligament tear
• Achilles tendon rupture
• Medial, lateral and anterior ankle tendon injury
• Ankle ligament tears
• Tarsal tunnel syndrome
• Sinus tarsi syndrome
• Tarsal/carpal coalition
• Talar OCD/osteochondral injury and AVN
• Morton’s neuroma
Recognize and give an appropriate differential diagnosis of at least the following imaging findings:
• Mono/poly arthropathies
• Lytic/radiolucent bony lesion (s)
• Sclerotic bony lesion (s)
• Osteopenia
• Sacroillitis
• Periosteal reaction
188
• Soft tissue calcification
• Soft tissue mass
2. Communicator
Dictate clear, detailed, and accurate reports that include all pertinent information as established in
the American College of Radiology (ACR) Guidelines for Communication.
Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of
musculoskeletal disease.
Communicate all unexpected or significant findings to the ordering provider and document whom
was called and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator
Effectively provide feedback to radiology technologists regarding quality of exposure and patient
positioning.
Recognize when it is appropriate to obtain help from faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care.
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
190
Neuroradiology: Level I (PGY2)
SUPERVISOR: Dr. Peter Bartlett, Health Sciences
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY2,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The
exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and
OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date.
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous
system and to be able to interpret and report associated imaging studies with an emphasis on Computed
Tomography.
Review and report all CT scans of head and spine performed at HSC site.
Where time allows, review some MRI studies to become familiar with this modality in preparation for the
PGY3 rotation.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures
such as lumbar puncture.
Submit (in power point format) 4 researched & prepared CNS cases as assigned by the end of the rotation.
1. Medical Expert
Know the gross anatomy of the central nervous system and review the pertinent aspects of functional
neuroanatomy.
Become exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow,
the resident should strive to obtain proficiency in these examinations.
Become familiar with the basic imaging sequences required in MRI scanning of the head and spine.
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Know the anatomy and pathology regarding the brain and spinal cord.
Normal Variants: Brain: Aging Brain, Arachnoid Granulations, Cavum Septi Pellucidi (CSP), Cavum
Velum Interpositum (CVI), Enlarged Perivascular Spaces. Spine: Conjoined Nerve Roots Spine, Incomplete
Fusion of Posterior Element Spine, Limbus Vertebra Spine.
Congenital/Genetic in the Adult: Brain Aqueductal Stenosis, Chiari Malformation, Dandy Walker
Continuum, Lipoma. Spine: Scheuermann Disease, Schmorl Node, Vertebral Segmentation Failure
Trauma: Brain Brain Death, Calvarium Fracture, Cerebral Contusion, Cerebral Edema, Diffuse Axonal
Injury (DAI), Epidural Hematoma, Herniation Syndromes, Missile and Penetrating Injury, Pneumocephalus,
Subarachnoid Hemorrhage, Subdural Hematoma. Spine: Plain radiograph and CT of spinal trauma is
covered in MSK, but reinforced in Neuroradiology.
Vascular Disease: Arteriolosclerosis, Carotid Cavernous Fistula, Cerebral Infarction, Cerebral Venous
Sinus Thrombosis, Hypertensive Hemorrhage, Small Vessel Ischemia, Spontaneous Intracranial
Hemorrhage, Aneurysmal Subarachnoid Hemorrhage, Nonaneurysmal Perimesencephalic SAH
Infection: Brain: Abscess, Extra-Axial Empyema, Herpes Encephalitis, Meningitis. Spine: Epidural
abscess.
192
Degenerative: Brain: Alzheimer Dementia, Multi-Infarct Dementia, Normal Pressure Hydrocephalus,
Obstructive Hydrocephalus, Porencephalic Cyst. Spine: Acquired Lumbar Canal Stenosis, Cervical Facet
Arthropathy, Degenerative Disc Disease, Degenerative Endplate Changes, Disc Herniation, DISH,
Spondylolisthesis, Spondylolysis, Synovial Cyst,
Neoplasm, Malignant: Brain: Metastases: Astrocytoma, Low Grade, Glioblastoma Multiforme, Primary
CNS Lymphoma, Oligodendroglioma. Spine: Metastatic Lesions, Multiple Myeloma,
Cysts, Non-neoplastic: Brain: Arachnoid Cyst, Colloid Cyst, Dermoid Cyst, Epidermoid Cyst. Pineal Cyst.
Spine: Perineural Root Sleeve Cyst,
2. Communicator
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call
and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3. Collaborator
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
193
Consult effectively with other physicians and health care professionals.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
194
Demonstrate integrity, honesty, compassion and respect for diversity.
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
195
Insert Mario’s Neuro/ENT Objectives here
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY3,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The
exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and
OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date.
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous
system and to be able to interpret and report associated imaging studies with an emphasis on Magnetic
Resonance Imaging.
Review and report all MRI scans of head and spine performed at HSC site.
Where time allows, review some MRI studies from the Janeway site and/or CT from the HSC site.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures
such as lumbar puncture.
Submit (in powerpoint format) 4 researched & prepared CNS cases as assigned to you by the end of the
rotation.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
196
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
1. Medical Expert
Know the gross anatomy of the central nervous system and to review the pertinent aspects of
functional neuroanatomy.
To be proficient in the interpretation of imaging studies in the evaluation of patients with neurological
and neurosurgical diseases.
To be exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow,
the resident should strive to obtain proficiency in these examinations.
To be familiar with the basic and advanced imaging sequences required in MRI scanning of the head
and spine. (Diffusion imaging)
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of
contrast.
Know the anatomy and pathology regarding the brain and spinal cord.
197
Trauma: Brain CSF Leak, Diffuse Axonal Injury (DAI), Extracranial Dissection, Intracranial Dissection,
Intracranial Hypotension Spine: Central Spinal Cord Syndrome, Contusion-Hematoma, Post-Traumatic
Syrinx,
Vascular Disease: CADASIL, Carotid Cavernous Fistula, Cerebral Amyloid Disease, Cerebral Ischemia-
Infarction/ Diffusion Imaging, Dural A-V Fistula, Hypertensive Encephalopathy, Hypotensive Cerebral
Infarction, Moyamoya, Persistent Trigeminal Artery, Primary Arteritis of the CNS, Vascular Loop Syndrome
(CPA-IAC), Vasculitis, Vertebrobasilar Insufficiency. Spine: Spinal Cord Infarction,
Vascular Disease, Malformations: Capillary Telangiectasia, Dural A-V Fistula, Vein of Galen Malformation
Infection: Brain: AOM with Complication, Apical Petrositis, Encephalitis, Fungal Diseases, Fungal Sinusitis,
HIV Encephalitis, Lyme Disease, Neurocysticercosis, Opportunistic Infection, AIDS, Tuberculosis,
Ventriculitis Spine: Epidural abscess, Viral Myelitis, Osteomyelitis/discitis.
Metabolic: Canavan Disease, Fahr Disease, Huntington Disease, Krabbe, Leigh Syndrome, MELAS,
Metachromatic Leukodystrophy (MLD), Paraneoplastic Disorders, Wilson Disease
X-Linked Adrenoleukodystrophy
Mesial Temporal Sclerosis, Multiple System Atrophy, Parkinson Disease, Pituitary Apoplexy
Wallerian Degeneration. Spine: Anular Tear, OPLL Spine, Ossification Ligamentum Flavum,
Cysts, Non-neoplastic: Brain: Choroid Plexus Cyst, Ependymal Cyst, Neurenteric Cyst, Neuroglial Cyst,
Rathke Cleft Cyst Spine: Syrinx, Arachnoid Cyst
198
Treatment-Related Lesions: CSF Leak, Failed Back Surgery Syndrome, Hardware Failure.
2. Communicator
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call
and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3. Collaborator
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
199
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
200
Neuroradiology: 2 months – Level III (PGY-5)
SUPERVISOR: Dr. Peter Bartlett, Health Sciences
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY5,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An
examination assessing knowledge obtained as per the listed curricula at each stage of training will be given
on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The
exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and
OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date.
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous
system and to be able to interpret and report associated imaging studies with an emphasis on both CT and
Magnetic Resonance Imaging.
Review and report all MRI scans of head and spine performed at HSC site.
Where time allows, review some MRI studies from the Janeway site and or CT from the HSC site.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures
such as lumbar puncture.
Submit (in powerpoint format) 4 researched & prepared CNS cases as assigned to you by the end of the
rotation.
201
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent
computed tomography (CT) and magnetic resonance (MR) examinations.
1. Medical Expert
To know the gross anatomy of the central nervous system and to review the pertinent
aspects of functional neuroanatomy.
To be familiar with the basic and advanced imaging sequences required in MRI scanning of
the head and spine. (Diffusion imaging)
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast.
Review all of the objectives in the PGY2 and PGY3 rotations. Elaborate on differential diagnosis with
reference to the specific case rather than repeating a standard list. The resident should be able to
function as a consultant by the end of this rotation.
2. Communicator
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call
and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by
communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
202
3. Collaborator
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting
referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Participate in discussions with faculty and staff regarding operational challenges and potential
system solutions regarding all aspects of radiologic services and patient care
203
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and
adhere to principles of patient confidentiality
204
Nuclear Medicine: PGY3 & PGY5
SUPERVISOR: Dr. Peter Hollett, Health Sciences Center
The following is an outline of the goals and objectives of the Nuclear Medicine rotation during PGY3 and
PGY5, incorporated into CanMEDS format. The CanMEDS roles will be assessed and remain consistent
throughout the Nuclear Medicine rotations as a PGY3 and PGY5, with the expectation that skills will be
further developed as a PGY5.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on
the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass
mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will
be completed at a later date.
Be aware of the complementary role that Nuclear Medicine provides in the overall imaging of patients with
illness.
Have an appreciation of the range of functional studies available within Nuclear Medicine.
Develop an expertise in the palpation of thyroid glands with a particular eye to being able to evaluate size,
texture and possible nodularity.
Provide at least two interesting case study reports for the interesting case file.
Possibly act as a consultant to other physicians seeking urgent or verbal reports of cases they have
reviewed with a senior Nuclear Medicine physician.
1. Medical Expert
Have a basic understanding of the physics of acquisition of Nuclear Medicine imaging and the
workings of a standard gamma camera. This would include the operation of crystals, photo multiplier
tubes, as well as the various aspects of collimator usage.
Know the anatomy and physiology of the skeleton as it applies to bone scans.
Understand the anatomy and physiology of the lungs as it applies to VQ scans. As well as
understand the categorization of lung scan reports into normal, low, intermediate or high probability
results.
Clinically examine the thyroid gland and understand the common diseases affecting the thyroid gland
including the significance of hot and cold nodules.
Understand the coronary anatomy and cardiac physiology as it applies to functional studies including
stress studies.
Understand the physics behind the production of bone mineral density studies and the application of
bone mineral density studies towards the diagnosis and treatment of osteoporosis.
Understand of the physics behind SPECT reconstruction including the recognition of common
artefacts such as centre of rotation artefact and other quality assurance matters.
Understand the production of radiopharmaceuticals, particularly the role of the moly 99/technetium
99m generator, as well as a grasp of the understanding of radiopharmaceutical kits and the quality
control procedures that must be performed on these kits prior to administration into patients.
Knowledge of the physical characteristics such as half-life photo peak and decay pattern of several
of the more common isotopes will be required.
Have a good understanding of the relative risk of radiation to the patient and, in particular, the risks
involved in both diagnostic and therapeutic Nuclear Medicine procedures, particularly in the
evaluation and treatment of patients with Grave’s disease and thyroid carcinoma.
Understand the nature of digital acquisition images and the role of computers and processing this
information particularly as it applies to functional Nuclear Medicine studies.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
206
Establish good relationships with peers and other health professionals while effectively providing and
receiving information. Handle conflict situations well.
Produce succinct reports that describe: findings, most likely diagnosis and where appropriate,
recommends further investigation or management.
3. Collaborator
Interact effectively with house staff and health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the quality control procedures related to preparing radiopharmaceuticals for patient
administration.
Understand the effective use of allocation and utilization of health care resources.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Understand and communicate the benefits and risks of nuclear medicine investigations including the
relative risk of radiation exposure to patients and environment.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
6. Scholar
207
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics
and experimental design.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and maintain appropriate professional behavior.
208
Obstetrical Ultrasound: PGY4 & PGY5
SUPERVISOR: Dr. Angela Pickles, Janeway
The assessment tools utilized during the rotations include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listing curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete,
and the rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists
will also be included in the ITER evaluation sheet. This will also include nursing staff.
Supervise and review all obstetrical ultrasonographic examinations. These will subsequently be reviewed
with the staff person prior to dictation by the resident.
Be available for consultation with the technologists and referring physicians/house staff.
Be responsible for i) Medical/Surgical rounds with staff supervision and ii) selective subspecialty rounds.
Protocol and arrange any fetal MRI’s which arise during the rotation.
209
1. Medical Expert
Know the normal anatomy of 1st and 2nd trimester sonography, including fetal echocardiography.
Be able to perform a complete 2-3 trimester obstetric ultrasound by completion of this rotation. It is
recommended that this be achieved in a step-wise fashion.
To know the radiology, pathology and clinical aspects of at least the following:
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
3. Collaborator
Establish good relationships with peers and other health professionals, particularly the Antenatal
Assessment Unit. Effectively provide and receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
4. Manager
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pregnant patient.
Know the benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness
guidelines.
6. Scholar
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
211
Pediatrics: Introductory Month
SUPERVISOR: Dr. Angela Pickles, Janeway
The assessment tools utilized during the rotations include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff. A printout of the complete
required modules from the online curriculum will be required.
As time permits, limited ultrasound exposure, particularly with regard to normal cranial sonography.
Complete Pediatric Radiology online curriculum sections for Junior Resident, as well as Upper Airway
Inflammation and Inflammatory Neck Lesions. Provide print out of completed courses to Karen. The website
can be accessed at: https://www.cchs.net/onlinelearning/default.htm
Become competent in interpreting plain films and performing basic procedures; namely, barium
swallows, UGI’s and follow-throughs, enemas, VCU’s and IVP’s, and fluoroscopy.
Be aware of how to tailor any general procedure to answer the specific clinical concerns, be aware of
radiation dosage and individual exposure in pediatrics.
Increase knowledge of anatomy and pathology related to organ systems with specific attention to the
pediatric population.
Start to familiarize yourself with ultrasound/CT/MRI examination for pediatric conditions and related
protocols.
Provide analgesia and sedation to pediatric patients when appropriate (MRI and CT).
Be able to read plain film studies of pediatric patients including the chest and musculoskeletal
system.
Complete Pediatric Radiology online curriculum sections for Junior Resident, as well as Upper
Airway Inflammation and Inflammatory Neck Lesions. Provide print out of completed courses to
Karen. The website can be accessed at: https://www.cchs.net/onlinelearning/default.htm
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
213
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits & risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
Know the benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness
guidelines.
6. Scholar
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and
implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics
and experimental design with respect to Radiology.
7. Professional
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice
graciously.
214
Pediatrics: PGY4 and PGY5
SUPERVISOR: Dr. Angela Pickles, Janeway
The assessment tools utilized during the rotations include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listing curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the pediatric technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff. A print out of the complete
required modules from the online curriculum will be required.
Ultrasound approximately 2 days per week minimum. The resident should be capable of scanning
independently and obtaining diagnostic images. The resident should provide an image of a normal appendix
scanned personally by the end of the rotation. The resident is responsible for reporting the majority of
ultrasounds on scheduled ultrasound days. At least one morning per week (minimum) hands-on scanning.
CT approximately 2 days per week. The resident will review all CT requisitions and decide on protocols with
the staff person. The resident will supervise and subsequently report all a.m. CT’s on scheduled days.
MRI – the resident will review and report the majority of pediatric MRI’s performed during the rotation.
The resident will be responsible for the same rounds and teaching file responsibilities as in the PGY2
rotation.
215
1. Medical Expert
Become competent in interpreting plain films and performing basic procedures; namely, barium
swallows, UGI’s and follow-throughs, enemas, VCU’s and IVP’s, and fluoroscopy.
Be aware of how to tailor any general procedure to answer the specific clinical concerns, be aware of
radiation dosage and individual exposure in pediatrics.
Increase knowledge of anatomy and pathology related to organ systems with specific attention to the
pediatric population.
Familiarize yourself with ultrasound/CT/MRI examination for pediatric conditions and related
protocols.
Complete Pediatric Radiology online curriculum sections for Senior Resident, as well as Upper
Airway Inflammation, and Inflammatory Neck Lesions and pediatric brain tumor sections in
Barkovich. Provide print out of completed courses.
Provide analgesia and sedation to pediatric patients when appropriate (MRI and CT).
Be able to read plain film studies of pediatric patients including the chest and musculoskeletal
system.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family. Provide clear
and thorough explanations of diagnosis, investigation and management.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate,
recommend further investigation or management.
Develop techniques for communication with apprehensive pediatric patients and parents.
3. Collaborator
Establish good relationships with peers and other health professionals. Effectively provide and
receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly
encouraged to interact with house staff and referring physicians as “first contact” in order to better
develop these skills. In addition, residents will be required to be active participants in inter and intra
discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
216
4. Manager
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
5. Health Advocate
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act
as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment,
including population screening and the risk of radiation exposure to the pediatric population.
6. Scholar
Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics
and experimental design with respect to Radiology.
Work up cases for the teaching file and identify a potential research project with supervisors.
7. Professional
Should we include a line about the plain film exam being done in advance of this rotation?
The following is an outline of the goals and objectives of the Rural rotation during PGY4, incorporated into
CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation.
Function as a community radiologist with exposure to all imaging modalities and subspecialties offered at
the WMRH.
Interpret and report all studies assigned to the supervising staff person. The supervising staff person will
change on a weekly basis. This will include plain films, GI/barium studies, mammography, CT, MRI and US.
Echocardiography and nuclear medicine are only reported by certain staff persons and exposure to these
modalities can be arranged if requested.
To perform, interpret and report procedures assigned to the supervising staff person. This includes GI
procedures, breast biopsies, thyroid biopsies, CT and US-guided biopsies and drainages. Complex
procedures are performed by the interventional staff person and exposure to higher-level interventional
procedures can be arranged if requested.
All “stat” studies should be reviewed and reported the day they are performed. Non-stat studies performed
during any given week should be reviewed and reported by Monday evening of the following week. The
resident is not expected to report any studies performed on the Friday of the last week of the rotation.
Friday AM the exam will be administered and all remaining studies should be reviewed, reported and signed
during the remainder of the day.
218
This is a general rotation and, as such, there are no specific reading requirements. One suggestion for
reading during this rotation would be to re-read Brant & Helms “Fundamentals of Diagnostic Radiology” in
preparation for exam-oriented study.
1. Medical Expert
Become competent in interpreting plain films and performing basic procedures; namely, barium
studies, basic US- and CT-guided procedures.
Be aware of how to tailor any general examination to answer the specific clinical concerns.
Increase knowledge of anatomy, physiology and pathology related to all organ systems.
Learn common ultrasound/CT/MRI examination protocols for all organ systems and be able to tailor
this appropriately for specific clinical concerns.
2. Communicator
Establish a therapeutic relationship with patients and communicate well with family while providing
clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and
receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate,
recommend further investigation or management.
3. Collaborator
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
4. Manager
Understand the effective use of allocation and utilization of health care resources with specific
attention to radiology.
Set realistic priorities and use time effectively in order to optimize professional performance.
5. Health Advocate
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an
advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment
including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
6. Scholar
Have a personal commitment of continued education and understand the importance of self
responsibility and the responsibility a radiologist has to patients, referring physicians and the
community.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and
experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills
should not, of course, be limited to this.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
7. Professional
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest
quality of care and appropriate professional behavior.
220
Demonstrate an awareness of personal limitations, seeking advice when necessary.
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound
rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
All emergency patients and inpatients are to be checked with the resident by the technologist, and should be
scanned by the resident in achieving the hands on scanning criteria listed below.
It is also the responsibility of the resident to obtain informed consent, as well as assisting staff, for all
patients that are scheduled to undergo ultrasound guided procedures during the rotation period.
As the volume of both emergency and inpatients, as well ultrasound guided procedures, can widely vary
during the course of the rotation, the resident should participate in the evaluation of other cases during the
work day as is reasonably achievable.
As a rough guideline, at least half of the cases preformed in the ultrasound department each day should be
evaluated by the resident, with review by the attending staff.
A contribution each week to interesting case rounds should also be made by the resident, using a case
during the rotation that emphasizes the role of ultrasound in imaging the patient and managing care period.
At least one case during the rotation should be submitted to the department teaching file. This is to be
reviewed with attending staff.
221
1. Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
By the end of the first level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.
ULTRASOUND PHYSICS
CLINICAL APPLICATIONS
Liver: normal echotecture, size and shape (including anatomic variants), diffuse
disease: (for example fatty infiltration, acute and chronic hepatitis, cirrhosis, edema),
focal masses, metastasis, granuloma
Gallbladder: normal appearance, wall thickening, gallstones, sludge, acute
cholecystitis (calculus vs acalculus), sonographic Murphy sign, other etiologies of wall
thickening, polyp
Bile ducts: normal, intra and extra hepatic bile duct diameters and dilatation
Pancreas: normal anatomy, pancreatic duct, mass
Spleen: normal echotexture, size and shape (including anatomic variants), focal
masses, cystic versus solid, lymphoma, abscess, infarction, granuloma
Peritoneal cavity: ascites, fluid localization/quantification(free versus loculated)
Pleural effusion
GENITOURINARY SYSTEM
Normal kidney cortical echotexture, size and shape, medical renal disease, simple
renal cyst
Ureters: hydronephrosis and pylenephrosis
Urinary bladder: caliculi, wall thickening, urethral jets, bladder volume
GYNECOLOGY
THYROID/NECK
VASCULAR/DOPPLER
223
Abdominal Aorta: normal appearance and measurement, aneurysm
Inferior vena cava: normal appearance, thrombosis
Lower extremity DVT
Hematoma
Pseudoaneurysm
SCROTUM
MUSCULOSKELETAL
Mass
Hematoma, Baker’s cyst, incomplete rupture
Abscess
INTERVENTIONAL
Informed consent
Sterile technique
Localization of fluid for paracentesis or thoracentesis, with ultrasound guided
aspiration of same
Techniques for ultrasound guided invasive procedures: understanding important
landmarks and pit falls of percutaneous procedures including recognition of critical
structures
Random core solid visceral biopsies
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator
Development effective communication skills with patients, patient families, physicians and other
members of the health care team.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behaviour when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam
224
3. Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4. Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5. Health Advocate
6. Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7. Professional
225
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
226
Ultrasound: (HSC) PGY 3
SUPERVISOR: Dr. Eric Sala, Health Sciences
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound
rotation during PGY3, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of
the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the
daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed
consent and assisting attending staff with all ultrasound guided procedures.
Weekly contribution to interesting case rounds with a case specifically pertaining to the role of
sonography is expected. Also, a contribution of at least one case per rotation to the departmental
teaching file is also expected.
Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
1. Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
227
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.
ULTRASOUND PHYSICS
CLINICAL APPLICATIONS
228
Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic
pancreatitis
Peritoneal cavity: abscess, hemorrhage, omental mass, metastases, carcinocmatosis
Spleen: varices
GENITOURINARY SYSTEM
GYNECOLOGY
THYROID/NECK
VASCULAR/DOPPLER
SCROTUM
229
Epididymitis, orchitis
Testicular torsion
Testicular mass characterization: microlithiasis, germ cell tumor, lymphoma,
metastases
Cystic ectasia of mediastinum testes
Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head
cyst
Varicocele
Trauma
MUSCULOSKELETAL
INTERVENTIONAL
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
230
3. Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4. Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5. Health Advocate
6. Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
231
7. Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
232
Ultrasound (HSC): Senior Rotations (PGY 4 & 5)
SUPERVISOR: Dr. Eric Sala, Health Sciences Centre
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound
rotation during PGY4 & 5, incorporated into CANMEDS format. The medical expert expectations have been
organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain
consistent throughout all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff.
At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover
the entire working of the department during the day. This includes reviewing all cases, as well as
obtaining informed consent for all ultrasound guided procedures.
Assisting the attending staff as well as independently performing these procedures is expected.
Continued weekly contribution to the interesting case rounds as well as the preparation of a case for
the departmental teaching file is also expected.
Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
1. Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
233
Know the role of ultrasound in situations of trauma.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.
ULTRASOUND PHYSICS
CLINICAL APPLICATIONS
Liver: trauma
Bile ducts: neoplasm (cholangiocarcinoma)
Spleen: trauma
Chest: pericardial effusion, mass, atelectasis, pneumonia
Organ transplants
Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease
Peritoneal cavity: free air
Abdominal wall hernia and inguinal hernia
GENITOURINARY SYSTEM
GYNECOLOGY
THYROID/NECK
Parathyroid mass
Congenital cyst: brachial cleft cyst
Lymph nodes: benign and malignant characterization
Post thyroidectomy recurrence
Submandibular and parotid glands: normal and abnormal
VASCULAR/DOPPLER
Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion
AV fistula
Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein
thrombosis, renal infarction, post biopsy complications, renal artery stenosis
Liver transplants, including hepatic artery stenosis or thrombosis, portal vein
thrombosis, post biopsy complications, IVC stenosis
Pancreas transplant
TIPS evaluation and complications
Arterial bypass graft, hemodialysis graft/fistula
Vertebral artery: subclavian steal syndrome
Mesenteric ischemia
Renal artery stenosis
SCROTUM
Hernia
Non descended testes
Fournier’s Gangrene
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator
235
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
3. Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4. Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5. Health Advocate
6. Scholar
236
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7. Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
237
Ultrasound: (SCM) Introductory Month
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY2, incorporated
into CANMEDS format. The medical expert expectations have been organized by year. The remaining
CANMEDS roles will be assessed throughout all rotations & will remain consistent throughout residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
All emergency patients and inpatients are to be checked with the resident by the technologist, and should be
scanned by the resident in achieving the hands on scanning criteria listed below.
It is also the responsibility of the resident to obtain informed consent, as well as assisting staff, for all
patients that are scheduled to undergo ultrasound guided procedures during the rotation period.
As the volume of both emergency and inpatients, as well ultrasound guided procedures, can widely vary
during the course of the rotation, the resident should participate in the evaluation of other cases during the
work day as is reasonably achievable.
As a rough guideline, at least half of the cases preformed in the ultrasound department each day should be
evaluated by the resident, with review by the attending staff.
A contribution each week to interesting case rounds should also be made by the resident, using a case
during the rotation that emphasizes the role of ultrasound in imaging the patient and managing care period.
At least one case during the rotation should be submitted to the department teaching file. This is to be
reviewed with attending staff.
1. Medical Expert
In addition to the acquisition of knowledge specific to ultrasound , there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
238
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Recognize & give the differential diagnosis of a lesion based on its anatomical location & echogenicity
By the end of the first level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.
ULTRASOUND PHYSICS
CLINICAL APPLICATIONS
Liver: normal echotecture, size and shape (including anatomic variants), diffuse
disease: (for example fatty infiltration, acute and chronic hepatitis, cirrhosis, edema),
focal masses, metastasis, granuloma
Gallbladder: normal appearance, wall thickening, gallstones, sludge, acute
cholecystitis (calculus vs acalculus), sonographic Murphy sign, other etiologies of wall
thickening, polyp
239
Bile ducts: normal, intra and extra hepatic bile duct diameters and dilatation
Pancreas: normal anatomy, pancreatic duct, mass
Spleen: normal echotexture, size and shape (including anatomic variants), focal
masses, cystic versus solid, lymphoma, abscess, infarction, granuloma
Peritoneal cavity: ascites, fluid localization/quantification(free versus loculated)
Pleural effusion
GENITOURINARY SYSTEM
Normal kidney cortical echotexture, size and shape, medical renal disease, simple
renal cyst
Ureters: hydronephrosis and pylenephrosis
Urinary bladder: caliculi, wall thickening, urethral jets, bladder volume
GYNECOLOGY
THYROID/NECK
VASCULAR/DOPPLER
SCROTUM
MUSCULOSKELETAL
Mass
Hematoma, Baker’s cyst, incomplete rupture
240
Abscess
INTERVENTIONAL
Informed consent
Sterile technique
Localization of fluid for paracentesis or thoracentesis, with ultrasound guided
aspiration of same
Techniques for ultrasound guided invasive procedures: understanding important
landmarks and pit falls of percutaneous procedures including recognition of critical
structures
Random core solid visceral biopsies
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
3. Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident reviewing cases & performing procedures.
4. Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
241
Use information technology to support patient care decisions.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5. Health Advocate
6. Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7. Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
242
Ultrasound: (SCM) PGY 3
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY3, incorporated
into CANMEDS format. The medical expert expectations have been organized by year. The remaining
CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of
residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also
be included in the ITER evaluation sheet. This will also include nursing staff.
In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of
the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the
daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed
consent and assisting attending staff with all ultrasound guided procedures.
Weekly contribution to interesting case rounds with a case specifically pertaining to the role of
sonography is expected. Also, a contribution of at least one case per rotation to the departmental
teaching file is also expected.
Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
1. Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
243
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.
ULTRASOUND PHYSICS
CLINICAL APPLICATIONS
244
GENITOURINARY SYSTEM
GYNECOLOGY
THYROID/NECK
VASCULAR/DOPPLER
SCROTUM
Epididymitis, orchitis
Testicular torsion
Testicular mass characterization: microlithiasis, germ cell tumor, lymphoma,
metastases
245
Cystic ectasia of mediastinum testes
Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head
cyst
Varicocele
Trauma
MUSCULOSKELETAL
INTERVENTIONAL
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
246
3. Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4. Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5. Health Advocate
6. Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
247
7. Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
248
Ultrasound: (SCM) Senior Rotations (PGY 4 & 5)
SUPERVISOR: Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY4 & 5,
incorporated into CANMEDS format. The medical expert expectations have been organized by year. The
remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout
all of residency.
The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation
evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of
training will be given on the last day. The examination will assess the acquisition of knowledge throughout
the rotation. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the
rotation will be completed at a later date. 360 degree evaluations by the ultrasound technologists will also be
included in the ITER evaluation sheet. This will also include nursing staff.
At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover the
entire working of the department during the day. This includes reviewing all cases, as well as obtaining
informed consent for all ultrasound guided procedures.
Assisting the attending staff as well as independently performing these procedures is expected.
Continued weekly contribution to the interesting case rounds as well as the preparation of a case for the
departmental teaching file is also expected.
Supplementary reading with the case review series, and both the general ultrasound, as well as the
obstetrical gynecological ultrasound volumes is recommended.
1. Medical Expert
In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the
resident will learn to scan during all rotations. In addition, a knowledge of physics specific to
ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using
ultrasound guidance will also be assessed.
Know the anatomy and pathology related to the body parts being scanned including the
musculoskeletal system, neck, pleural space, abdomen and pelvis.
Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and
musculoskeletal system.
Recognize and give the differential diagnosis of a lesion based on its anatomical location and
echogenicity.
249
Perform an ultrasound guided biopsy and ultrasound guided drainage.
By the end of each level of training, the resident should be able to scan most clinical
scenarios listed below in each training category.
ULTRASOUND PHYSICS
CLINICAL APPLICATIONS
Liver: trauma
Bile ducts: neoplasm (cholangiocarcinoma)
Spleen: trauma
Chest: pericardial effusion, mass, atelectasis, pneumonia
Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease
Peritoneal cavity: free air
Abdominal wall hernia and inguinal hernia
GENITOURINARY SYSTEM
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Peritoneal inclusion cyst
Ovarian cancer staging
Early obstetrics: unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary
horn)
THYROID/NECK
Parathyroid mass
Congenital cyst: brachial cleft cyst
Lymph nodes: benign and malignant characterization
Post thyroidectomy recurrence
Submandibular and parotid glands: normal and abnormal
VASCULAR/DOPPLER
Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion
AV fistula
Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein
thrombosis, renal infarction, post biopsy complications, renal artery stenosis
Liver transplants, including hepatic artery stenosis or thrombosis, portal vein
thrombosis, post biopsy complications, IVC stenosis
TIPS evaluation and complications
Arterial bypass graft, hemodialysis graft/fistula
Vertebral artery: subclavian steal syndrome
Mesenteric ischemia
Renal artery stenosis
SCROTUM
Hernia
Non descended testes
Fournier’s Gangrene
Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:
2. Communicator
Develop effective communication skills with patients, patient families, physicians and other members
of the health care team.
Dictate accurate and concise radiological reports for more complex studies with concise impression
and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or
management.
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Communicate effectively and demonstrate caring, respectful behavior when interacting with patients
and their families, answering their questions and helping them to understand the ultrasound
procedure as well as its clinical significance and as well understand the importance of the
physician/patient interaction during an ultrasound exam.
3. Collaborator
Interact with residents and attending physicians in consultation when clinical and radiologic
correlation is necessary.
If there are medical students rotating through the department during electives, time spent by the
medical student in ultrasound should be with the resident in reviewing cases and performing
procedures.
4. Manager
Use information technology to manage information, to access online medical information and for self
learning.
Understand how medical decisions affect patient care within a larger system.
Know how types of ultrasound practice and delivery systems differ from one another.
Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise
the quality of care.
5. Health Advocate
6. Scholar
Demonstrate knowledge of principles of research methods, statistical methods, study design and
their implementation.
Demonstrate knowledge and application of the principles of evidence based medicine in practice.
Facilitate teaching of medical students, stenographers, other residents and other health care
professionals.
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Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
7. Professional
Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health
care professionals.
Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).
The work day begins at 8:00 and the resident is expected to be present on time.
In cases where the resident is unable to attend to patients in the department for any reason
(including having to attend rounds/teaching sessions, or other duties), the resident is expected to
communicate this with both the attending staff as well as the ultrasound technologist, in order to
ensure no interruption in delivery of patient care.
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Appendix One
Policy
Overview
Resident education must occur in a physically safe environment (Royal College of Physicians and Surgeons
of Canada, standard A.2.5; College of Family Physicians of Canada).
The collective agreement between the Professional Association of Interns and Residents of NL (PAIRN)
states that residents are postgraduate trainees registered in university programs as well as physicians
employed by the hospitals. The agreement states that the residents must have secure and private rooms
with secure access between call room facilities and the service area; maximum duty hours are defined;
uniforms and protective equipment standards; as well as access to and coverage for Occupational Health
services.
Memorial University is committed to provide and maintain healthy and safe working and learning
environments for all employees, trainees (including postgraduate trainees), volunteers and visitors. This is
achieved by observing best practices which meet or exceed the standards to comply with legislative
requirements as contained in the NL Occupational Health and Safety Act, Environmental Protection Act,
Nuclear Safety and Control Act and other statutes, their regulations, and the policy and procedures
established by the University.
Purpose
To demonstrate the commitment of Postgraduate Medicine, Faculty of Medicine, to health, safety and
protection of its postgraduate medical trainees.
To minimize the risk of injury and promote a safe and healthy environment on the university campus and
affiliated teaching sites
To provide a procedure to report hazardous or unsafe training conditions and injury along with a mechanism
to take corrective action
Policy
PERSONAL SAFETY
Memorial University, Faculty of Medicine strives for a safe and secure environment for postgraduate trainees
to train in its facilities and training sites through maintenance of affiliation agreements. Affiliated hospitals
are responsible for ensuring the safety and security of postgraduate trainees training and supervision in their
facilities in compliance with their existing employee safety and security policies/procedures as well as the
requirements outlined in the PAIRN – Eastern Health collective agreement.
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It is expected that the Postgraduate Trainee, the Residency Program and the Postgraduate Medical
Education Office will work together with the affiliated teaching hospitals and community training sites to
ensure the personal safety of all Postgraduate trainees.
Accommodation
When trainees rotate in sites that are out of town accommodations should have adequate security and
lighting, safe locks and security personnel available to accompany the trainee to their residence after dark.
Responsibility
1. Postgraduate Trainee
It is the responsibility of the trainee to participate in required safety sessions, which include
Workplace Hazardous Materials Information and Safety (WHMIS), Fire Safety (as required), etc. and
abide by the Safety codes of the designated area where s / he is training. This includes dress codes,
particularly as they relate to safety.
The Postgraduate trainee must report any situation where personal safety is threatened (see Faculty
Protocol below).
It is a responsibility of each Residency Program and the Postgraduate Medical Education Office to
ensure that appropriate educational safety sessions are available to all Postgraduate Trainees e.g.,
generic WHMIS and safety training. In addition to WHMIS, the Residency Program must ensure that
there is an initial, specialty, site-specific orientation available to the Postgraduate trainee.
It is the responsibility of the Residency Program to ensure that individual clinics or practice settings
develop a site specific protocol to deal with:
The protocol must be communicated to the Postgraduate Trainee at the beginning of the rotation.
The Postgraduate Medical Education Office will work, in conjunction with the affiliated Newfoundland and
Labrador teaching hospitals to ensure that hospital areas are in compliance with the requirements as
outlined in the PAIRN – Eastern Health collective agreement.
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a. while the Postgraduate Trainee is seeing a patient after hours in clinic. This would not
apply if the patient is being seen in an emergency room / hospital based urgent care
clinic, nursing home and hospice
b. when the Postgraduate Trainee does home visits
c. at the end of office hours if the Postgraduate Trainee is still with patients
*The supervisor as defined by the Occupational Health and Safety Act – “a person who has charge of a
workplace or authority over any worker.” It can be a physician (including another Postgraduate Trainee),
midwife, nurse practitioner or social worker depending on the encounter.
Faculty Protocol
1. If a Postgraduate Trainee identifies a personal safety or security breach, it must be reported to their
immediate supervisor and/or Program Director to allow resolution of the issue at the local level.
2. If a Postgraduate Trainee feels that his / her own personal safety is threatened, s/he should seek
immediate assistance and remove themselves from the situation in a professional manner. The
Postgraduate Trainee should ensure that their immediate supervisor has been notified and/or
Program Director, as appropriate.
3. The Postgraduate Medical Education Office is available for consultation during regular work hours,
particularly if the Program Director is not available. If an issue arises after regular office hours, where
the clinical supervisor and/or Program Director may not be available, contact Security of the institution
where the Postgraduate trainee is based.
Travel
If in the residents’ estimation, it would not be safe to travel because of weather, the resident may elect not to
attend their academic half day, clinic, etc., but must inform the appropriate people as soon as possible in a
professional manner.
Postgraduate Trainees must complete the Field Trips and Electives Planning and Approval process when
planning to do an elective outside of North America to ensure compliance with standards and best practices
for the safety of all Postgraduate Trainees
(e.g. hazardous material (biological or chemical agent named in the Occupational Health and Safety Act),
indoor air quality, chemical spills)
OCCUPATIONAL HEALTH
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Both Memorial University and its employees are jointly responsible for implementing and maintaining an
Internal Responsibility System directed at promoting health and safety, preventing incidents involving
occupational injuries and illnesses or adverse effects upon the natural environment.
The University is responsible for the provision of information, training, equipment and resources to support
the Internal Responsibility System and ensure compliance with all relevant statutes, this policy and internal
health and safety programs. Managers, Supervisors, Deans, Directors, Chairs, Research Supervisors are
accountable for the safety of postgraduate trainees who work/study within their area of jurisdiction.
Postgraduate trainees are required by University policy to comply with all University health, safety and
environmental programs such as Workplace Hazardous Materials Information and Safety (WHMIS).
The Faculty of Medicine and the teaching hospitals each are responsible for ensuring that postgraduate
trainees are adequately instructed in infection prevention and control as it relates to communicable
diseases.
The Faculty and the teaching hospitals will provide an introductory program on routine practices / standard
precautions, infection protection and control that is consistent with current guidelines and occupational
health and safety. In addition, the Faculty and the teaching hospitals will inform postgraduate trainees as to
their responsibilities with respect to infection prevention and control and occupational health and safety.
Affiliated teaching hospitals are required to comply with the Communicable Disease Surveillance Protocols
for Newfoundland and Labrador Hospitals. Compliance with these Protocols requires the hospitals, in
liaison with the University’s academic programs, to provide instruction in infection prevention and control and
occupational health and safety.
The Faculty Postgraduate Medical Education Office collects the immunization data on all Postgraduate
Trainees on behalf of the teaching hospitals.
If an injury occurs while working, the injury must be reported as follows (Refer to Chart 1 on page 7)
• During daytime hours, while working at one of the Newfoundland and Labrador hospitals:
The Postgraduate Trainee should go to the Employee Health Office at any of the teaching hospitals.
An incident form will be provided by the Employee Health office to the Postgraduate Trainee.
Reporting: All trainees are encouraged to submit a copy of the incident form to their home program
for notification. The home program will send a copy to the Postgraduate Medical Education Office for
University records. Non-Ministry of Health funded trainees: (e.g., foreign sponsored Residents
and all Clinical Fellows *) must submit a copy of the incident form to the Postgraduate Medical
Education Office, in order for the PGME Office to notify their sponsor and ensure proper follow-up.
Occupational Health & Safety Office of the University will be notified.
• During the evening or on the weekend at one of the Newfoundland and Labrador teaching hospitals
or if working at a training site outside of the Newfoundland and Labrador area
The Postgraduate Trainee should go to the nearest Emergency Room and identify themselves as a
Resident / Clinical Fellow and request to be seen on an urgent basis. The Postgraduate
Trainee must complete, within 24 hours, an Injury/Incident Report (forms should be available in the
local Emergency Room).
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The injury/incident form should be submitted to the hospital where the injury took place. That
hospital will be responsible for administering the claim.
*The Postgraduate Trainee’s employer administers the claim. All Ministry of Health funded Residents are
paid through Eastern Health. There are a variety of different funding sources for externally funded
Residents and Clinical Fellows. In these instances, HHS would not administer the claim or be responsible
for follow-up. Important: Please see Appendix 1 for information on follow-up.
Resources available:
Phone: 709-777-6680
Fax: 709-777-6680
Definitions
RELATED LINKS
Liaison Committee on Medical Education: http://www.lcme.org
Procedure
Definitions
List links in alphabetical order, indicating title of link and destination, as in the following examples:
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Appendix Two
PATIENT RELATIONSHIPS:
5. Patients like and talk easily to him/her. 5. Unable to see the patient's point of view.
6. Patients can discuss intimate and sensitive 6. Becomes dependent on the emotional
details with him/her. content of the doctor/patient relationship.
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Comments for Tutor
This behaviour objective clearly involves giving a trainee responsibility for care - not always easy.
Clearly, patients and their families are the tutor's best guide to the trainee's success. Occasionally an
insensitive student will upset patients with resultant tutor reluctance to give the student more responsibility in
this area, when the student's need is greatest. We suggest that initially you pass the patient's comments on
to the trainee with a minimum of comment and continue to give the student responsibility, checking the
reactions of suitable patients.
Acceptable behaviour:
1. Takes a history whose comprehensiveness is clearly related to the needs of the patient and the
nature of the complaint.
Unacceptable behaviour:
Chart review should reveal obvious defects and improvement after discussion. Occasionally, students differ
from tutors in what they consider to be their responsibility for taking histories. This area must be clearly
defined at the outset.
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CLINICAL PROBLEM IN DELINEATION AND SOLUTION
Acceptable behaviour:
Unacceptable behaviour:
2. Unable to interpret or ignores the unexpected item which does not fit.
3. Thinking is rigid and not adequately related to the variations in different patient's lives.
4. Fails to consider alternate solutions and does not diverge sufficiently before reaching a conclusion.
5. Fails to consider the effect on diagnosis of basic variables such as commonness, age of patient and
duration of symptoms.
The average active primary care physician may make 6,000 diagnoses every year. To do this, he/she
manipulates a diagnostic vocabulary of approximately 475 diagnoses. The average PGY I trainee at the end
of his/her rotations has probably learned to manipulate 200 - 250 diagnoses. The natural history of the extra
225+ diagnoses may be learned from primary physicians or from specialists or other members of the health
care team. This is the most valuable skill you have to teach. If students require help in this area we suggest
"Towards Earlier Diagnosis in Primary Care" (5th Edition), K. Hodgkin, in the library.
Acceptable behaviour:
1. Is familiar with the uses and limits of any treatment that he/she uses.
2. Is aware of side effects and dangers of any treatment that he/she prescribes.
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3. Simple inexpensive treatment is used first.
6. He/she takes the patient into his/her confidence or fully explains what he/she is doing.
Unacceptable behaviour:
3. Treatment techniques are rigid and inflexible or inappropriate for the patient's home.
5. Needlessly complex or expensive treatments are used when simpler procedures are available.
This is also an extremely valuable area for the trainee's learning and is often very personal to each tutor.
Please teach what you actually do. Thus, if you are prescribing antibiotics to children with respiratory
disease for geographical or social rather than bacteriological reasons, please teach and discuss your actual
reasons.
EMERGENCY CARE
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Acceptable behaviour:
Unacceptable behaviour:
5. Unable to delegate.
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Comments for Tutor
This trainee will rarely be involved in many of these situations but despite this, try to involve him/her in as
many emergency situations as you can.
Please also involve the trainee in any telephone conversations with supportive consultants who are in any
way contacted when helping you to deal with emergency situations. The telephone relationship with
supportive obstetrician or pediatrician 100 or so miles away is a valuable and under stressed primary care
tool that we would like you to emphasize whenever possible.
He/she should also learn the consultant value of the social worker, public health nurse, priest or minister,
etc.
Acceptable behaviour:
2. Recognizes the need to assess preventative care in terms of cost, to government as well as patients.
4. Keen to try out, evaluate and dissect new ideas in this field.
Unacceptable behaviour:
This is a difficult area to teach and most trainees are not involved in this area enough.
Perhaps the best and most useful persons to teach this are the public health nurse, social worker,
pediatrician and public health physician.
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CONTINUING CARE AND RESPONSIBILITY
Acceptable behaviour:
Unacceptable behaviour:
1. Loses interest after initial treatment.
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Comments for Tutor
Continuity of care is difficult to teach in our PGY I program because trainees are never very long in one
situation.
We believe that a doctor doesn't really learn the realities of continuous care until he/she has been in his/her
own practice with his/her own patients for at least two years but you can, however, teach the trainee much
about continuity even in a short space.
a) In chart review always give your own summary of the appropriate social and family history.
b) Keeping good records and discussing the histories of patients who have been under your care for years.
c) Making the trainee give you family and social history summaries when he/she presents a problem to you.
Acceptable behaviour:
1. Gets on well with people because he/she is conscious of their needs and tries to satisfy and
recognize their contribution.
Unacceptable behaviour:
1. Has difficulty with personal relations and lacks the ability to give and take instructions.
2. Tactless and inconsiderate in relation to vital matters, e.g., workload, time off, pay.
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Comments for Tutor
Involve the trainee in telephone consultations, practice meetings and local doctors' meetings. Also get
feedback about the trainee's relationship with other trainees, consultants and paramedicals.
If possible, check and discuss his/her letters of referral to consultants, laboratories and social agencies, etc.
THE ABILITY TO DEVELOP OBJECTIVE RESEARCH METHODS TO ANALYZE AND HANDLE THE
COMMON MEDICAL/SOCIAL PROBLEMS OF THE EVER CHANGING COMMUNITY IN WHICH THE
PHYSICIAN WORKS AND LIVES
Acceptable behaviour:
1. Looks at an idea objectively and can formulate a null hypothesis related to it.
2. Is interested in the objective comparison of two or more groups of clinical cases and is prepared to
accept that an attractive hypothesis may well be wrong.
4. Can think in terms of comparing the characteristics of two relevant objectively selected groups.
Unacceptable behaviour:
2. Tends to be more interested in the emotive and products of an idea and not in the objective
evaluation of it.
3. Cannot understand the need to have independent criteria for selection of groups of cases for
comparison.
We have included this objective in the hope that interested tutors may involve the trainee in any research
which they do and also as a potential objective for the PGY I trainee who is going on to a residency.
THE ABILITY TO USE AND DEVELOP THE MANY TOOLS OR SERVICES THAT ARE AVAILABLE TO
THE PRIMARY PHYSICIAN
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Acceptable behaviour:
Unacceptable behaviour:
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Comments for Tutor
Where possible, get feedback from personnel in charge of services and check letters of referral; teach by
example. If you are successful in the above areas, your student will have a role model.
Acceptable behaviour:
1. Although may be initially threatened by self- evaluation, very soon comes to enjoy the process and
sets up further similar discussions, etc.
3. Can analyze interactions with difficult patients in terms of his/her own as well as the patient's
difficulties.
6. Is aware of his/her deficiencies in current medical knowledge and anxious to take remedial action in
important areas.
Unacceptable behaviour:
1. Is clearly threatened by self-evaluation procedures such as discussion of mistakes in inadequacies,
role-play, etc.
An occasional session on your own mistakes is helpful and illuminating in this area, as in an account of how
you solve the dilemmas of continuing medical education for yourself.