Description of Rotation or Educational Experience

This is a one month required rotation for the acute care surgical resident. While on this rotation at University Medical Center, residents will acquire a broad understanding of the evaluation and management of patients with diseases and injuries that require interventional radiology intervention.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Determine the appropriateness of patient selection for a requested procedure through review of available history, imaging, laboratory values and proposed/expected outcomes of the procedure, as well as obtain deficient information in these areas.
• Demonstrate understanding of history/physical findings or treatment scenarios that would require pre-procedure assistance from other specialty disciplines such as cardiology, anesthesia, surgery and internal medicine.
• Obtain informed consent after a review with the patient of the procedure(s), risks, benefits and alternative therapeutic options/procedures.
• Recognize monitoring abnormalities and physical signs/symptoms that need immediate attention during a procedure.
• Demonstrate appropriate post procedure recovery, patient management and follow-up.
• Demonstrate understanding and appropriate management of certain pharmacological considerations:

  a. Drug/Contrast Reactions

  b. Antibiotic Therapy

  c. Conscious Sedation

  d. Anesthesia/Analgesia

• Explain the risk:reward ratios of surgical care for patients with vascular disease and review the costs associated with providing surgical care to patients with vascular disorders.
• Be prepared to explain the following concept: vascular disease, and specifically arterial disease may be diffuse and clinically silent, but it still represents a major threat to the patient.

Objectives

• Insertion of PICC lines using ultrasound guidance
• Diagnostic angiography with endovascular treatment (balloon/stent/coil)
• Ultrasound-guided biopsy or drainage
• CT-guided biopsy or drainage
• Insertion/removal of vena cava filter
• Diagnostic aortography

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Demonstrate knowledge of basic anatomy, physiology, pharmacology and pathology as it relates interventional radiology and its diverse methods.
• Understand the indications and contraindications of the major interventional procedures.
• Understand the principles of guide-wire, catheter, and balloon and device selection in the context of therapeutic endovascular surgery.
• Understand the principles and approaches to percutaneous biopsy and drainage procedures.
• Understand the clinical anatomy appropriate to all procedures performed.
• Describe the basic clinical manifestations of vascular injuries and diseases.
• Indicate the role of anticoagulant agents, including antiplatelet agents, in the management of patients with vascular disease.

Objectives

• Create a power point presentation that overviews equipment and techniques utilized in the standard interventional radiology procedures
• Pass an oral evaluation given by the preceptor during the rotation.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.
• Use information technology to optimize learning.

Objectives

• Create at least one power point presentation of sufficient quality to be included in the resident lecture databank.

Or

• Complete a research project under the supervision of the rotation preceptor.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Participate in identifying systems errors and in implementing potential systems solutions

Objectives

• While on service, act as primary consultant to referring physicians and other members of the health care team and definitively arrange appropriate procedures (under direct supervision of preceptor).
• Participation in weekly departmental quality assessment/quality improvement meetings

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Responsiveness to patient needs that supersedes self-interest
• Accountability to patients, society, and the profession

Objectives

• Obtain satisfactory or above ratings on nursing- and physician-filed evaluations in the category of professionalism

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients, colleagues, referring physicians and other members of the health care team concerning imaging appropriateness, informed consent, safety issues and results of imaging tests or procedures.
• Maintain comprehensive, timely and legible medical records.

Objectives

• Obtain satisfactory or above ratings on nursing- and physician-filed evaluations in the area of communication
• Production of accurate and appropriate diagnostic and procedural reports.

Teaching Methods

• Attendance of all lectures, conferences and quality improvement meetings.
• Review of assigned reading materials
• Attending preceptorship

Assessment Method (residents)

• Focused observation by faculty staff
• 360 degree evaluation by faculty at end of rotation through e-value system.
• Case log review with program director

Assessment Method (Program Evaluation)

• Using e-value system, rotation is assessed on several qualities including but not limited to value, accessibility, and relevance to practice.
• Outcome on national standardized exams.

Level of Supervision

• Residents are under direct or indirect supervision by faculty staff at all times.

Educational Resources

• Department-recommended texts and journals provided
• On-site medical library
• Internet access for review and research