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Service Expectations

MEDICAL KNOWLEDGE

Outline of medical knowledge expectations during residency training in interventional radiology:

All level residents–cumulative through exposure to IR/Neuro IR rotations and conferences.

  • Understand the role of IR diagnosis and management of patients with a broad variety of conditions. Understand the role of various imaging modalities for diagnosis and to understand the role of percutaneous therapy in the management of the disease process including the risks, benefits and alternatives of IR management:

VASCULAR DISEASE

  1. Vascular occlusive disease
    1. Aortic
    2. Peripheral
    3. Neuro
    4. Renal
    5. Mesenteric
    6. CNS/Carotid
    7. Cardiac (imaging)
  2.  Thoracic and abdominal aortic aneurysm/dissection/atherosclerotic disease
    1. Endograft management and technique
  3.  Pulmonary
    1.  Embolic disease
    2. Vascular malformations
  4. Venous thrombotic disease
    1. Diagnosis
    2. Management
    3. IVC filters and removal filters
    4. Thrombolysis
  5. Renal dialysis fistula and graft management/intervention including management of venous stenoses/angioplasty and endovascular stent and stent-graft placement
  6. Bleeding—diagnosis and IR management strategies
    1.  Mesenteric
    2. Variceal
    3. Trauma
    4. Hempotysis/bronchial artery hemorrhage
  7. Arterial thrombosis/embolus and percutaneous management strategies
    1.  Patient assessment
    2. Patient evaluation
    3. Interventional therapy
      • Thrombolysis
      • Thrombectomy
      • Embolectomy 

STROKE

  1. Clinical evaluation and management
  2. Imaging evaluation
  3. Intervention
  4. Post intervention management

WOMEN’S HEALTH

  1. Management of patients with symptomatic uterine fibroids
  2. Infertility
  3. Chronic pelvic pain/congestion syndrome

INTERVENTIONAL ONCOLOGY

  1. Indications and contraindications for regional IR guided therapies
    1. TACE
    2. RFA ablation–liver-lung-kidney-bone
    3. Cryoablation–liver-lung-kidney-bone
    4. New ablative therapy
  2. Preoperative assessment of patients
  3. Post operative management of patients

IMAGE GUIDED PAIN MANAGEMENT (Pending)

  1. Patient assessment
  2. Image guided techniques for pain relief 

ANCILLARY SUPPORT SERVICES

  1. Vascular access
    1. Lines and tunneled catheters
    2. Port placement and removal
  2. Drainage
    1. Percutaneous nephrostomy
    2. Cholangiography/biliary drainage
    3. Abscess evaluation/management/drainage
    4. Thoracentisis
    5. Paracentesis
  3. Miscellaneous
    1. PCNL for large stones
    2. Strictures/biliary/ureteral
    3. Stone retrieval/percutaneous removal
    4. Percutaneous gastrostomy, gastrojejunal tube placement
    5. Intravascular FB removal
    6. Testicular vein embolization/Ovarian vein embolization
    7. Biopsy with imaging guidance

PATIENT CARE

The IR service is the radiology laboratory of patient care. It is on this service that residents will master the art of caring for patients with all of its attendant responsibilities. During the IR residency months, residents will master the following objectives:

  • Understand the role of the interventional radiologist and interventional procedures in the diagnosis and treatment of a broad variety of clinical problems–outlined above.
  • Understand the indications for IR driven procedures
  • Understand contraindications for IR driven procedures
  • Understand the critical import of INFORMED CONSENT.
  • Understand principals of IR inpatient care with a clear understanding of service limitations and the role of supporting consultants. 

INTERPERSONAL AND COMMUNICATION SKILLS

The IR service offers a rich clinical environment in which residents master ACGME driven competencies in interpersonal and communication skills. During the IR residency experience, residents will have the opportunity in a graded fashion to:

  • Communicate with patients, families regarding the nature of illness, proposed evaluative measures and therapeutic interventions.
  • communicate with patients in language that patients and other lay personnel can easily comprehend
  • communicate with physicians, nurses and ancillary technical staff regarding the care delivered to specific patients
  • communicate as a consultant to those seeking professional advice and opinion
  • integrate with other members of the health care team
  • communicate findings through effective written and oral reports in all capacities

PROFESSIONALISM

In conjunction with the development of effective communications and patient care skills, the resident in IR will conduct himself/herself with the following attributes:

  • compassion
  • responsiveness to patient interest
  • respect for privacy
  • sensitivity to diverse patient cultural and ethnic backgrounds.

PRACTICE-BASED LEARNING

Residents on the IR service are to begin to assimilate an understanding of practice based learning objectives and their application to interventional radiology.

  • On each rotation, the resident will identify one IR learning improvement goal or deficiency that can be remedied through individual research and presentation to the IR team.
  • On each rotation, the resident will be examined by an attending physician on an “unknown” case that will simulate a board-level interaction commensurate with the resident’s experience level. The resident will be expected to identify the findings, outline an appropriate course of management and discuss potential complications and clinical considerations. Patient management will be emphasized.

SYSTEMS BASED PRACTICED

The IR service represents a rich environment of opportunity to develop familiarity and expertise in an integrated, electronic medical record. During IR rotations residents, in addition to assimilation of the UAMS/CAVAH PACS and RIS programs are expected to develop facility utilizing the clinical management tools utilized by each institution.

  • Sunrise
  • Logician (outpatient where appropriate-upper level residents and fellows)
  • CHCS
  • WEB CHART
  • EPF