Overall Program Goals
The goal of the IR fellowship program is to have our trainees provide patient care through safe, efficient, appropriately utilized, quality-controlled diagnostic and/or interventional radiology techniques. At the conclusion of fellowship training, the trainee will be able to:
- Understand the essential components of direct patient management during an entire episode of care surrounding performance of an image-guided procedure, including pre-procedure assessment and post- procedure management in both the inpatient and outpatient setting.
- Understand the criteria used to select patients for image-guided procedures based on history, physical examination, imaging studies, laboratory analysis, and proposed/expected procedural outcomes.
- Understand the interaction that interventional radiologists must have with other specialties to provide comprehensive patient care.
- Understand the interaction that interventional radiologists must have with the member of the IR team (nurses, technologists, mid-level providers, secretaries) to successfully care for patients.
- Understand the clinical presentation, diagnosis, treatment, and long-term management of the vascular and nonvascular disease processes commonly encountered and treated by interventional radiologists.
- Demonstrate technical proficiency in the performance of image-guided procedures commonly performed by interventional radiologists.
- Understand the importance of ongoing quality improvement initiatives within interventional radiology with the goals of improving patient safety, reducing errors, and improving patient outcomes.
Competency-Based Objectives
Patient Care: Fellows must demonstrate an ability to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. By the end of the year, fellows will be expected to:
- Evaluate a patient prior to an image-guided procedure in the inpatient or outpatient setting with preparation of a thorough consultation that includes a history, physical examination, review of medications, lab studies, and imaging studies, and the formation of an assessment and plan.
- Obtain informed consent from a patient after discussing the potential risks and benefits of a proposed procedure and alternative therapeutic options.
- Competently perform all medical and invasive procedures considered essential for the practice of Interventional Radiology.
- Demonstrate the appropriate utilization of sterile technique during invasive procedures.
- Identify factors from a patient’s history, physical examination, and laboratory values that allows for the assignment of an ASA score to indicate potential risk for conscious sedation.
- Identify factors from a patient’s history, physical examination, and laboratory values that indicate potential risks for bleeding, cardiovascular problems, respiratory abnormalities, renal injury, and adverse drug interactions during or after an interventional procedure.
- Supervise physiologic monitoring before, during, and after image-guided procedures and recognize the abnormalities and physical signs/symptoms that require immediate attention during a procedure.
- Administer and maintain effective moderate sedation/analgesia for patient comfort during and after an interventional procedure.
- Demonstrate an understanding of how to manage certain pharmacological considerations surrounding the performance of image-guided procedures (e.g., drug/contrast reactions, antibiotic therapy, moderate sedation, analgesia, anticoagulation, blood pressure, diabetes management).
- Provide appropriate patient follow-up in the inpatient and outpatient setting with effective communication to referring physicians.
- Recognize and treat complications that may potentially arise during and after image-guided procedures (e.g., contrast/anaphylactic reaction, over-sedation, pain, nausea/vomiting, decreased oxygen saturation, hypertensive urgency/emergency, low blood pressure, hyper-hypoglycemia or bleeding/hematoma).
- Demonstrate an understanding of radiation exposure during image-guided procedures. Fellows must be able to apply radiation safety principles in performing interventional procedures and are expected to:
- Identify the types of radiation created and their sources during fluoroscopy.
- Identify the organs especially sensitive to the effects of ionizing radiation and the maximum yearly whole body dose.
- Understand how radiation exposure is monitored.
- Understand the principles and practical applications of radiation protection.
- Understand the rationale for lead protective clothing, lead glasses, shields and gloves.
- Identify periodic maintenance and maintenance schedules for radiation protection.
- Understand methods to decrease radiation dose to the patient and operator during IR procedures.
- Demonstrate an understanding of the risk of occupational injury during the performance of image-guided procedures. Specifically, fellows should be able to:
- Describe how to limit/reduce work related musculoskeletal injuries in the IR environment. - Identify patients at high risk for blood borne pathogens.
- Know the incidence of hepatitis-C in the IR patient population
- Describe methods to reduce accidental exposure to blood and body fluids in the IR suite.
Medical Knowledge: Fellows must demonstrate knowledge about established and evolving biomedical, clinical, epidemiological and social-behavioral sciences and the application of this knowledge to patient care. By the end of the year, fellows will be expected to:
- Engage in continuous learning and apply appropriate state of the art diagnostic and/or interventional radiology techniques to meet the clinical needs of the patients, referring physicians, and the health care system.
- Demonstrate that they read IR-related textbooks and journals in the context of their training.
- Attend weekly didactic lectures in Interventional Radiology and participate in topic-based discussions at the weekly IR Fellow’s conference.
- Attend and actively participate in multidisciplinary conferences (such as GI tumor board).
- Attend national Interventional Radiology conferences.
- Actively participate in IR-related research projects leading to presentation and/or publication at local, regional, national, or international meetings.
Practice-Based Learning and Improvement: Fellows must be able to investigate, evaluate, and improve patient care practices. By the end of the year, fellows will be expected to:
- Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.
- Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
- Attend and actively participate in Interventional Radiology Morbidity and Mortality Conference and the Interventional Radiology Quality Improvement Meeting with the goal of systemically analyzing the quality of IR practice.
- Facilitate the learning of students and other health care professionals.
- Use information technology to manage patient care, access on-line medical information, and support one’s own education and the education of diagnostic radiology residents and medical students.
Interpersonal and Communication Skills: Fellows must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates. By the end of the year, fellows will be expected to:
- Work effectively with others as a member or leader of a health care team or other professional group.
- Effectively coordinate on-call emergency procedures.
- Demonstrate the ability to dictate timely and appropriate reports for diagnostic imaging studies and interventional radiology procedures.
- Effectively communicate with referring physicians and consultants regarding procedure appropriateness and potential risks that require further evaluation prior to performance of an image-guided procedure.
- Effectively communicate with patients and their families in a caring manner regarding the medical conditions being treated, the image-guided procedures being performed, and how these procedures t into an overall treatment plan.
Professionalism: Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. By the end of the year, fellows will be expected to:
- Demonstrate a commitment to high standards of professional conduct, including altruism, compassion, honesty, and integrity.
- Follow principles of ethics and confidentiality and consider religious, ethnic, gender, educational, and other differences in interacting with patients and other members of the health care team.
- Demonstrate a commitment to excellence and on-going professional development.
- Comply with institutional and departmental requirements (dress code, wearing and submitting radiation badges, displaying ID, etc.)
- Serve as a role model for residents and medical students.
- Demonstrate a willingness to perform additional duties that contribute to the overall patient care and academic interests of the section.
Systems-Based Practice: Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
- Understand how the components of the local and national healthcare system function independently and how changes to improve the system involve group and individual efforts.
- Understand the systems used for procedure coding (CPT) and diagnosis coding (ICD9) for the billing of procedural services in interventional radiology.
- Practice cost-effective health care and resource allocation that does not compromise quality of care.
- Consult with other healthcare professionals and educate healthcare consumers regarding the most appropriate utilization of imaging resources.
- Demonstrate a willingness to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.