UNIVERSITY OF MINNESOTA

GRADUATE MEDICAL EDUCATION

2010-2011PROGRAM

POLICY & PROCEDURE MANUAL

Department of Radiology

Interventional Radiology Fellowship

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i. INTRODUCTION

DEPARTMENT OF RADIOLOGY PROGRAM MANUAL

All physicians-in-training at the University are classified as either residents or fellows. The information contained in this Program Manual pertains to all residents in the Department’s programs except as otherwise identified in the Program Manual or addendum. This Manual outlines benefits, policies, guidelines and other regulations that apply to all resident training in the Department of Radiology.

The Institutional Policy Manual contains policies, procedures and information that apply to all residents throughout the University of Minnesota Medical School. The Program Manual is specific to each program. All materials are intended to be written in accordance with the Accreditation Council for Graduate Medical Education (ACGME). Please note that the Institutional Policy Manual and the Department Program Manual are designed to work together. Information contained in Institutional Policy Manual may not be replicated in Program Manual.

All information outlined in this Program Manual is subject to periodic review and change. All residents are subject to, and required to be familiar with and to comply with all policies and procedures of the University including the Institutional Policy and Department Program Manuals.

Throughout this Manual, individual institutions will be identified as follows:- University of Minnesota Medical Center: UMMC - Veterans Affairs Medical Center: VAMC- Hennepin County Medical Center: HCMC

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ii. DEPARTMENT MISSION STATEMENT

The mission of the Department of Radiology is to be a leader in enhancing the health of people through education, biomedical research, and clinical programs.

iii. PROGRAM MISSION STATEMENT

The Department of Radiology at the University of Minnesota School of Medicine, in conjunction with its affiliated institutions (including but not limited to the Veterans Affairs Medical Center and Hennepin County Medical Center) provides graduate medical education in Diagnostic Radiology and its subspecialties programs:

Breast Imaging Fellowship Diagnostic Radiology Residency Neuroradiology Fellowship Nuclear Medicine Fellowship Pediatric Fellowship Thoraco-Abdominal Radiology Fellowship Vascular and Interventional Radiology Fellowship

Our educational mission is to provide an atmosphere of learning and academic curiosity, and to provide strong basic training in diagnostic radiology and its subspecialties including but not limited to breast, cardiac, abdominal, musculoskeletal, neuro-, pediatric, noninvasive vascular, and thoracic imaging, as well as nuclear radiology and ultrasound.

Administrative oversight of these programs is provided by the ALRT Administrative Center - Departments of:AnesthesiologyLaboratory Medicine and Pathology, Diagnostic Radiology Therapeutic Radiology

The mission of the A.L.R.T. Administrative Center, as part of the University of Minnesota School of Medicine, is to provide uniform service delivery to our departments and institutes. These services consist of human resources, payroll, communication, education, grants management, financial reporting and budget. Our goal is to provide exceptional service while balancing the expectations of the multiple constituents. To achieve this goal we will foster a community based on communication, cooperation and expertise by drawing on our individual backgrounds, strengths and unique histories.

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TABLE OF CONTENTS

SECTION i. INTRODUCTION Page 2SECTION ii DEPARTMENT AND PROGRAM MISSION STATEMENTS Page 3SECTION I. Student ServicesUniversal University Pagers Page 6E-mail and Internet Access Page 6Campus Mail Page 6Tuition and Fees Page 7HIPAA Training & Data Security

Page 7

SECTION II. BENEFITS

Stipends Page 8Paychecks and Pay Periods Page 8Resident/Fellow Leave Page 8 Vacation Page 9 Illness Page 9 Other Leaves Page 9

Personal Leaves of Absence Page 9 Family Medical Leave Page 9 Family Medical Leave Act (FMLA) Page 9 Parental Leave for Childbirth Page 9 Parental/Domestic Partnership Leave – Adoption Page 10 Professional Leave Page 11 Military Leave Page 11 Jury Witness Duty Page 11 Bereavement Leave Page 11

Policy on Effect of Leave - ABR Certificate of Added Qualification Requirement

Page 11

Holiday Schedule Block Out Dates

Page 12Page 12

Department Policy Regarding Pregnancy for Resident/Fellow & Radiation

Page 13

Notary Service Page 13Resident/Fellow Exercise Room Page 13Health and Dental Insurance Page 13Long-Term Disability Insurance Page 13Short-Term Disability Insurance Page 14Professional Liability Insurance Page 14Life Insurance Page 14Voluntary Life Insurance Page 14Insurance Coverage Change Page 14Worker’s Compensation Page 14Meal/Food Services Page 14Laundry Services Page 14Parking Page 15 UMMC Page 15 VAMC Page 15Travel/Academic Fund Page 15SECTION III. INSTITUTIONAL RESPONSIBILITIES Page 15 SECTION IV. DISCIPLINARY AND GRIEVANCE PROCEDURES Page 16Discipline/Dismissal for Academic Reasons Page 16Discipline/Dismissal for Non-academic Reasons Page 16

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Grievance Procedure and Due Process Page 16

SECTION V. GENERAL POLICIES AND PROCEDURES PAGE 17IR Program Description Page 17Program Goals & Objectives Page 18-23Didactic Lecture Schedule Page 22IR Fellow Core Rotations Page 23IR Fellow Clinical Responsibilities Page 23Supervision/Graded Responsibility Page 24-27Program Requirements Page 27Training/Graduation Requirements Page 28ACGME Competencies Page 28Duty Hours Page 28RMS – Residency Management Suite

Duty Hour Approval Policy/ProcedurePage 28-29

Duty Hours – Entering Hours Into RMS Page 29On-call Activities Page 31On-call Rooms Page 31Support Services Page 31Laboratory Medicine/Radiology Services Page 32Medical Records Page 32Security/Safety Page 32Radiation Badges Page 32Moonlighting Page 32Steps in Evaluation Process Page 33Evaluation System - Electronic Page 33Completing Evaluations in RMS Page 33Monitoring of Fellow Well-being Page 34ACLS/BLS Certification Requirements Page 34Travel Page 34Libraries

Institutional Departmental

Page 34-35

Goals and Objective for Teaching Medical Students Page 35-38SECTION VII. ADMINISTRATION CONTACT INFORMATION Page 38Graduate Medical Education Directors and Coordinators Page 38Site Addresses, Phone and Fax Numbers Page 39Declaration of Duty Hours Page 40Confirmation of Receipt of Program Manual Page 41

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SECTION I. STUDENT SERVICES (Please refer to Institution Policy Manual at http://www.med.umn.edu/gme/residents/parta.html for Medical School Policies on the following: Academic Health Center (AHC) Portal Access; Child Care; Computer Discount/University Bookstore; Credit Unions; Disability Accommodations; Legal Services; Library Services; Medical School Campus Maps; Resident Assistance Program; University Card (UCard); University Events Box Office; University Recreation Sports Center(s))

UNIVERSAL UNIVERSITY PAGERS

Fellows are assigned UMMC-Fairview pagers at the beginning of their year. Contact Zalika Muskat, Program Coordinator, 612-626-5388 or murr0300@umn.edu to report any missing or malfunctioning cards.

E-MAIL AND INTERNET ACCESS

As students at the University, all residents are provided with a University E-mail/Internet access account. With this account trainees can access the Internet and E-mail from any of their assigned training sites.

If you are using an independent ISP, you must forward your University E-mail account to your preferred E-mail account as required by the Medical School. Log on to http://www.umn.edu/validate to do so. (To learn the E-mail address assigned to you, go to the University’s web page, www.umn.edu, click on “People Search” then type your name into the “Search” box.)

Information regarding the University of Minnesota School of Medicine, Graduate Medical Education and/or the Department of Radiology can be located at the following web sites:

Medical School Web Site: http://www.med.umn.eduGraduate Medical Education Administration Web Site:

http://www.med.umn.edu/gmeDepartment of Radiology Web Site:http://www.radiology.umn.edu

Trainees are required to maintain an E-mail account and to check their E-mail daily for Program, Medical School and University notices.

CAMPUS MAIL

DEPARTMENT MAILROOM: ROOM B-221, MAYO MEMORIAL BUILDING OUTGOING MAIL Can be left in the “Outgoing Hospital/Campus Mail” basket.

INCOMING MAIL Fellows may receive professional related mail in their mailbox.

DEPARTMENT MAILING ADDRESS420 Delaware Street. S.E., MMC 292Minneapolis, MN. 55455

Fellows are not to send or receive personal mail through the University system. Outgoing U.S. mail may also be placed in the United States Postal Service mailbox located just outside the main entrance of the University of Minnesota Medical Center (on Harvard Street).

The mailbox at UMMC is the trainee’s MAIN mailbox, but VAMC also has mailboxes for fellows. The department is not responsible for moving mail between hospitals depending on your rotation.

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Fellows are required to check their mailboxes a WEEKLY basis for Program, Medical School and University notices. Fellows are also required to empty their mailboxes on a regular basis.

TUITION AND FEES

Tuition and fees are being waived at this time. Fellows who are enrolled in Graduate School pay tuition and fees.

HIPAA AND DATA SECURITY TRAINING

The University of Minnesota is required to remain in compliance with the training component of the Federal Health Information Portability and Accountability Act (HIPAA) privacy regulations and Data Security. All faculty, trainees and staff must be trained regarding this regulation as well as University-specific policies and procedures. Multi-media online training has been developed to facilitate this training as well as the required documentation in the regulation. Four courses have been developed and are available through the “My AHC” and “My U” portals.

All University faculty, staff, student workers and health science students and volunteers are required to complete the following HIPAA Privacy and Data Security courses:

HIPAA Privacy Introduction to HIPAA Privacy Video Privacy and Confidentiality in Research (for research faculty and staff) Privacy and Confidentiality in Clinical settings (for clinical faculty and staff)

HIPAA Data Security Data Security in Your Job Securing Your Computer Workstation Using University Data Managing Health Data Securely

To access your HIPAA and Data Security Training and to complete the course(s), please follow this link: www.myU.umn.edu (log in with your x500).

Please remember to LOG OUT of the portal when you are finished. If you leave the computer while you remain logged in, others could use your log-in to access your private information.

SECURITY/PRIVACY COORDINATOR Sally Sawyer, Graduate Medical Education Manager, serves as the ALRT Center Privacy Coordinator. Questions and/or concerns can be directed to Sally at 612-625-3518 or sallyann@umn.edu.

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SECTION II. BENEFITS (Please refer to Institution Policy Manual at

http://www.med.umn.edu/gme/residents/parta.html for Medical School Policies on the following: Boynton Health Services; Employee Health Services; Exercise Room at UMMC-F; FICA; Dental Insurance; Health Insurance; Life Insurance; Voluntary Life Insurance; Long-Term Disability; Short-Term Disability; Insurance Coverage Changes; Bereavement Leave; Family Medical Leave Act (FMLA); Holidays; Medical Leave; Military Leave; Parental Leave; Personal Leave; Professional Leave; Vacation/Sick Leave; Witness/Jury Duty; Effect of Leave for Satisfying Completion of Program; Loan Deferment; Minnesota Medical Association Membership; Minnesota Medical Foundation Emergency Loan Program; Pre-Tax Flexible Spending Accounts; Professional Liability Insurance; Stipends; Workers’ Compensation Benefits; Veterans Certification for Education Benefits).

STIPENDS

Medical Fellows who meet Departmental, Medical School and University requirements are appointed to one-year training positions from July 1 through June 30 of the following year (unless otherwise agreed to in writing).

Base stipend rates are posted at http://www.med.umn.edu/gme/residents/stipendinfo/home.html

Medical Residents/Fellows are subject to withholding of Federal and State income taxes, as well as FICA taxes (Social Security). Medical Residents/Fellows pay insurance fees by payroll deduction over 26 pay periods.

PAYCHECKS AND PAY PERIODS

Biweekly paychecks are issued every-other Thursday, beginning July 1st, 2010.

You are encouraged to have your checks automatically deposited to your banking institution to avoid loss or delay. Your pay statement can be viewed online at http://hrss.umn.edu. If you do not have direct deposit you will receive a check on payday. This check must be picked-up from ALRT Payroll (7th floor Mayo Building). It cannot be placed in your mailbox or mailed to your home. Please keep your pay statements for future reference, as they contain deduction amounts that you’ll need when you prepare your tax returns. The Department of Radiology keeps no record of your deductions.

Payroll forms (i.e., automatic deposit, W4, duplicate W2, etc.), can be obtained online at http://hrss.umn.edu A new W4 form must be completed each time a name or address change occurs.

CONTACT PERSON:Contact Sandy Connor at 612-625-3682 or schap002@umn.edu regarding questions pertaining to payroll, taxes, deductions, W2s, etc.

RESIDENT/FELLOW LEAVE (INCLUDING VACATION, ILLNESS AND OTHER TYPES OF LEAVE)Except for unexpected absence related to illness, all leave must be pre-approved. All leave must be documented in RMS duty hours.

The Program Coordinator should be concurrently notified of leave requests by e-mail as soon as possible. The type of leave, as noted below, should be specified. Depending on scheduling considerations and in a timely manner, send an e-mail to the Program Coordinator including attached revised schedule noting changes for final approval by the Program Director.

Unpaid Leave While on unpaid leave, the fellow is responsible for payment of any insurance (fellows on unpaid leave will be billed monthly).

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1. VACATION Holiday schedule (including variation by location) and “block out dates” are indicated on page 12. Up to twenty (20) working days per year may be taken as vacation which is paid leave. Unused vacation time may not be carried over to the next year. Depending on rotation up to five (5) vacation days may be taken during a given month. Requests to exceed this limit must be approved by the Program Director in advance. No more than ten (10) total vacation days can be taken from any section during the fellowship without the Program Director’s approval.

TERMINAL LEAVE IN THE EVENT THE GRADUATING FELLOW HAS VACATION TIME REMAINING, VACATION MAY BE REQUESTED DURING THE BLOCKED OUT TERMINAL LEAVE PERIOD AT THE END OF THEIR FELLOWSHIP.

2. ILLNESS

Fellows must call in sick as soon as they know they are unable to show up for work because of acute illness of themselves or child/children. They must inform the Program Coordinator, Zalika Muskat (612-626-5388), and the rotation they’re on. They should speak in person with either the fellowship coordinator, or someone in their rotation.

Days of absence due to illness are considered paid leave up to ten (10) days per year. Absence due to illness exceeding ten (10) work days in an academic year will be charged as vacation. There is no carryover from preceding years. In the event that a fellows has exhausted all of his/her vacation leave, this time will be charged as unpaid leave. While on unpaid leave, the fellow is responsible for payment of any insurance fellows on unpaid leave will be billed monthly).

3. OTHER LEAVES PERSONAL LEAVE OF ABSENCE If vacation time is used up for the year, and upon the approval of the Program Director, a

fellow may arrange for a unpaid leave of absence away from the training program. While on unpaid leave, the fellow is responsible for payment of any insurance (residents on unpaid leave will be billed monthly).

MEDICAL LEAVE An unpaid leave of absence (greater than 14 days) for serious illness of the resident; serious health condition of a spouse, parent or child/children; shall be granted through formal request. The Program Coordinator should be concurrently notified of the leave request by e-mail as soon as possible. The length of leave will be determined by the Program Director based upon an individual’s particular circumstances and the needs of the department, not to exceed twelve (12) weeks in any 12-month period. The trainee may qualify for Short Term and Long Term Disability benefits. 

Fellows taking family medical leave must submit the following documents to the

OSHB:

FMLA: Certification of Health Care ProviderFMLA: Leave Response/Notification

The above forms can be accessed online in the Forms Library under “Human Resources” at http://policy.umn.edu/Forms/formresults.cfm?TitleCode=fmla&go.x=13&go.y=10

***While on unpaid leave, the fellow is responsible for payment of any insurance (fellows on unpaid leave will be billed monthly).

FAMILY MEDICAL LEAVE ACT (FMLA)

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FMLA is intended to allow employees to balance their work and family life by taking reasonable unpaid leave for a serious health condition, for the birth or adoption of a child, and for the care of a child, spouse, and registered same-sex domestic partner provided for by the University, or parent who has a serious health condition. The Act is intended to balance the demands of the workplace with the needs of families, to promote the stability and economic security of families, and to promote national interests in preserving family integrity.

http://www1.umn.edu/ohr/policies/leaves/fmla.html

PARENTAL LEAVE FOR CHILDBIRTH The resident/fellow (trainee) as defined below must give notice, in writing, of intent to use parental leave and other leaves used in conjunction with parental leave to their program director and program coordinator at least four (4) weeks in advance, except under unusual circumstances.

  Birth mother:A birth mother shall be granted, upon request to the program director, up to six weeks parental (maternity) leave for the birth of a child.  The maternity leave may begin at the time requested by the trainee, but no later than six weeks after the birth and no sooner than two weeks before the birth. The paid leave must fall within the term of appointment and must be taken consecutively and without interruption. After using paid maternity leave and all unused vacation, any additional leave will be without pay. While on unpaid leave, the fellow is responsible for payment of any insurance (fellow on unpaid leave will be billed monthly)

Trainees on maternity leave will receive the first two weeks of their leave as paid parental leave.  This paid parental leave shall not be charged against the trainees’ vacation, sick or PTO allocation.

 Note: The first two weeks of this paid parental leave covers the required fourteen day wait period before they may be eligible to receive the short-term disability benefit, see Short Term Disability Policy.

 Birth father:A birth father shall be granted, upon request to the program director & program coordinator, up to two weeks paid parental leave for the birth of a child. The leave may begin at the time requested by the trainee, but no later than six weeks after the birth and no sooner than two weeks before the birth. All leave time must fall within the term of appointment and must be taken consecutively and without interruption. After using all unused vacation, any additional leave will be without pay. While on unpaid leave, the fellow is responsible for payment of any insurance (fellows on unpaid leave will be billed monthly). This paid parental leave shall not be charged against the trainees’ vacation, sick or PTO allocation.

 Registered same sex domestic partner:Registered same sex domestic partner of someone giving birth shall be granted, upon request to the program director, up to two weeks paid parental leave. The leave may begin at the time requested by the trainee, but no later than six weeks after the birth and no sooner than two weeks before the birth.  All leave time must fall within the term of appointment and must be taken consecutively and without interruption. After using all unused vacation, any additional leave will be without pay. While on unpaid leave, the fellow is responsible for payment of any insurance (fellows on unpaid leave will be billed monthly). This paid parental leave shall not be charged against the trainees’ vacation, sick or PTO allocation.

 Adoption:An adoptive parent shall be granted, upon request to the program director, up to two weeks paid parental leave for the adoption of a child.  Trainees who are registered same sex

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domestic partners of someone adopting a child shall be granted two weeks paid leave.  The leave may begin at the time requested by the trainee, but no later than six weeks after the adoption and no sooner than two weeks before the adoption. The leave must be consecutive and without interruption.  This paid parental leave shall not be charged against the trainees’ vacation, sick or PTO allocation.

 Clarification*Holidays that occur during a leave of absence run concurrent with the leave and are not in addition to the leave.

*Disabilities associated with childbirth and pregnancy will be treated like any other disability.

ACADEMIC/PROFESSIONAL LEAVE At the Fellowship Director's discretion, additional time may be granted as paid leave for academic leave and conferences. This time is in addition to regular vacation time and is at the discretion of the Program Director or Department Head.

The Department may cover up to three days of reasonable expenses for fellow presenting at regional or national meetings.

MILITARY LEAVE Military leave is granted in full accordance with State and Federal regulations. The Program Director must be promptly notified in writing when a Medical Fellows requires military leave.

JURY/WITNESS DUTY Jury duty and court leave will be authorized consistent with State and Federal Court requirements. The Program Director must be promptly notified in writing when a Medical Fellow requires jury duty or court leave.

BEREAVEMENT LEAVE A fellow may request bereavement leave through formal request of the Program Director.

Either sick or vacation time must be used. The Program Coordinator should be concurrently notified of leave requests by e-mail as soon as possible.

POLICY ON EFFECT OF LEAVE FOR SATISFYING COMPLETION OF PROGRAM As is required by the American Board of Radiology (ABR), all fellow leave is reported to the ABR on an annual basis. Per the ABR, the following terms in regards to leave must be met in order to be eligible to sit for the Certificate of Added Qualification examination:

“Leaves of absence and vacation may be granted to fellows at the discretion of the

program director in accordance with local rules.

Within the required period(s) of graduate medical education, the total such leave and

vacation time may not exceed six calendar weeks (30 working days) for fellows in a

program for one year.”

ABR REQUIREMENTS:

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Requirements

You must successfully complete one year of fellowship training (after residency) in a vascular

and interventional radiology program approved for such training and accredited by the ACGME

or by the RCPSC (Canada). You must also complete one year of practice or additional approved

training, with one-third of that year spent in vascular and interventional radiology.

Fellowship training must be documented by letter from the program director.

Practice experience must be verified by letter from the chief of service or department

chairman.

Provide procedure logs from fellowship and practice year.

Provide current state medical license with expiration date.

HOLIDAY SCHEDULE AND BLOCK-OUT DATES

Holiday schedules vary, depending on the institution. When rotating to a particular site, the holiday schedule for that institution must be followed.

The fellows should not request vacation during the block out dates below.

Date Holiday UMMC

HCMC VAMC

Monday, July 5th, 2010Independence

DayYes Yes Yes

Monday, September 6th, 2010

Labor Day Yes Yes Yes

Monday, October 11, 2010 Columbus Day No No Yes

Thursday, November 11, 2010 Veterans Day No No Yes

Thursday, November 25, 2010

Thanksgiving Day

No No No

Friday, November 26, 2010

Floating Holiday Yes Yes Yes

Friday, December 24th, 2010

Christmas Holiday Yes Yes Yes

Monday, December 27th, 2010 Floating Holiday

Yes No No

Friday, December 31, 2010

New Year’s Day (Observed)

Yes Yes Yes

Monday, January 17, 2011

ML King Day (Observed)

No No Yes

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Monday, February 15, 2011 Presidents’ Day

No No Yes

Monday, May 30, 2011 Memorial Day Yes Yes Yes

BLOCK-OUT DATESEvent From: Through:

New Residents and Fellows July 1, 2010 July 6, 2010

Vascular Interventional Advances (VIVA)

October 19th, 2010 October 22, 2010

Int’l Symposium, of Endovascular Therapy (ISET)

January 16, 2011 January 20, 2011

Society for Interventional Radiology Annual Meeting (SIR)

March 13, 2011 March 18, 2011

Global Embolization Symposium & Technologies

(GEST)April 27th, 2011 April 30, 2011

DEPARTMENTAL POLICY REGARDING PREGNANCY FOR FELLOWS

The Department of Radiology will not differentiate in the treatment of potentially pregnant or confirmed pregnant fellows. Specifically, on-call and fluoroscopy assignments will not be modified solely on the basis of a female resident being potentially pregnant or pregnant, in accordance with the official position of the American Association of Women in Radiology which states: “On the basis of available data, the elimination of fluoroscopy at any time during pregnancy cannot be justified on scientific grounds. Rationally, women of child-bearing age who enter the specialty of radiology should be willing to accept the theoretical risks involved in fluoroscopy.”

NOTARY SERVICE Shari Johnston

Phone: 612.626.5589, Office: Mayo B-211 Trisha Pederson

Phone: 612.626.5548, Office: Mayo B-292

RESIDENT/FELLOW EXERCISE ROOM

The University of Minnesota Medical Center, Fairview Medical Executive Committee has graciously provided an exercise facility for use by University of Minnesota residents and fellows.

Location:Room C-496 Mayo Memorial Building(Locker rooms/showers are located directly across the hall)

Hours:The facility is open 24 hours a day, 7 days a week

Access Code to Exercise Room and Locker Rooms:9111 (Please do not share with anyone other than residents and fellows)

The space also includes a small kitchenette area with refrigerator, microwave, coffeemaker and hot/cold water dispenser.

HEALTH AND DENTAL INSURANCE COVERAGE

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Please refer to Institutional Policy Manual for further information. You may also contact the Office of Student Health Benefits (OSHB)

http://www.shb.umn.edu/twincities/residents-fellows-medical.htm

FLEXIBLE SPENDING ACCOUNT

Please refer to Institutional Policy Manual for further information. You may also contact the Office of Student Health Benefits (OSHB).

http://www.shb.umn.edu/twincities/residents-fellows-medical.htm

LONG-TERM DISABILITY INSURANCE COVERAGE

Please refer to Institutional Policy Manual for further information. You may also contact:

Guardian Disability InsuranceDale Forsythe920 2nd Ave South, Suite 1100 Minneapolis, MN 55402Phone: (612)746-2206http://www.guardiandisabilitymnrf.com

SHORT-TERM DISABILITY INSURANCE COVERAGE

Please refer to Institutional Policy Manual for further information. You may also contact:

Guardian Disability InsuranceDale Forsythe920 2nd Ave South, Suite 1100 Minneapolis, MN 55402Phone: (612)746-2206http://www.guardiandisabilitymnrf.com

PROFESSIONAL LIABILITY INSURANCE COVERAGE

Please refer to Institutional Policy Manual for further information. You may also contact the Risk Management Office:

Office of Risk Management and Insurance1300 South 2nd Street, Suite #208 WBOB, Minneapolis, MN 55454 Phone: 612-624-

5884

LIFE INSURANCE COVERAGE

Please refer to Institutional Policy Manual for further information. You may also contact the Office of Student Health Benefits (OSHB).

http://www.shb.umn.edu/twincities/residents-fellows-medical.htm

VOLUNTARY LIFE INSURANCE COVERAGE

You may also contact the Office of Student Health Benefits (OSHB).

http://www.shb.umn.edu/twincities/residents-fellows-medical.htm

INSURANCE COVERAGE CHANGES

You may also contact the Office of Student Health Benefits (OSHB).

http://www.shb.umn.edu/twincities/residents-fellows-medical.htm

WORKER’S COMPENSATION

University employees must promptly report on-the-job injuries/illnesses to the employee's supervisor. Within 24 hours of the employee's report the supervisor shall complete the First

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Report of Injury and the Employee Incident Report forms and forward these to the University's vendor and a copy to the University Workers' Compensation Department.

http://www.policy.umn.edu/groups/ppd/documents/policy/workers_comp

Meals/Food ServicesFellows on duty have access to adequate and appropriate food services at all institutions.

UMMC Fellowsmay visit the Bridges Cafeteria (University campus) or the East Side Market Café (Riverside

campus). *************There are no meal plans provided by the Department for Fellows.

LAUNDRY SERVICES

Two lab coats will be provided at the beginning of your fellowship. If you should require a replacement lab coat during your fellowship program, please contact, Zalika Muskat, Program Coordinator.

No laundry services are provided for Radiology fellows. Scrubs are provided at all three institutions when you are on an appropriate rotation for scrubs. These are the property of the institutions and are to be used for this purpose only.

- UMMC:Scrubs are available on a sign-out basis by using your UMMC identification badge in Room J2-104. The required bar code for the backside of your ID badge is provided by Kathy Monitor in Linen Services: 612-273-5793.

- VAMC: Lab coats and scrubs are available on a sign-out basis by providing your VAMC identification badge to the VAMC Laundry (Room 1N-104).

PARKING

UMMC The Department provides general parking at Oak Street Ramp C for residents. Fellows receive a parking card during their department orientation at the beginning of the year. If you encounter a problem with your parking card, contact Trisha Pederson, Program Coordinator at 612-626-5548.

DO NOT TAKE YOUR KEY CARD INTO ANY MRI FACILITY, AS THESE UNITS WILL ERASE THE CARD’S MEMORY. EXITING PARKING FACILITY WITHOUT SCANNING CARD WILL AUTOMATICALLY RESULT IN YOUR CARD BEING LOCKED

ON-CALL PARKING: The Department covers parking expenses for residents taking departmental call. Those with departmental parking cards will use the same card for on-call parking as for daily parking when rotating to UMMC.

AFTER-HOURS PARKING Parking validation is available to residents for the sole purpose of attending Program-related conferences and activities while on rotations based away from UMMC (i.e., Diagnostic Radiology and Medical School Core Curriculum lectures, First-year Lecture Series, Physics Review, Senior Review and resident meetings). Parking tickets can be validated by the Program Coordinator.

VAMC Residents may park in either the general parking lot or in the gated physician lot using VA ID badge.

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TRAVEL FUND Some funding is available for academic items and conference participation at the Fellowship director's discretion. Support up to $2000 may be provided.

SECTION III. INSTITUTIONAL RESPONSBILITIES (Please refer to Institution Policy Manual athttp://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on the following: ACGME Resident Survey Requirements; ACGME Site Visit Preparation Services; Institution Affiliation Agreements; Program Letters of Agreement; Confirmation of Receipt of Program Policy Manuals; Duty Hour Monitoring at the Institution Level Policy and Procedure; Funding; GME Competency Teaching Resources and Core Curriculum; Graduate Medical Education Committee Responsibilities; Graduate Medical Education Committee Resident Council Responsibilities; Institution and Program Requirements; Internal Review Process; International Medical Graduates Visa Requirements; New Training Program Approval Process; Orientation; Registration Policy ).

SECTION IV. DISCIPLINARY AND GRIEVANCE PROCEDURES (Please refer to Institution Policy Manual at

http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on the following: Discipline/Dismissal/Nonrenewal; Conflict Resolution Process for Student Academic Complaints; Academic Incivility Policy and Procedure; University Senate on Sexual Harassment Policy; Sexual Harassment and Discrimination Reporting; Sexual Assault Victim’s Rights Policy; Dispute Resolution Policy)

Discipline/Dismissal for Academic ReasonsTrainee academic performance is determined by a review of evaluations and examination scores (see Section IV: Steps in Evaluation Process). If resident performance is felt to be below an acceptable level, discipline and possible dismissal will follow guidelines set forth in the Institutional Policy Manual (see Disciplinary and Grievance Procedures).

Procedures: The resident/fellow will be given verbal notice of performance deficiencies by the Program Director, an opportunity to remedy deficiencies, and the notice of possible dismissal or contract non-renewal if the deficiencies are not corrected, and a record of this will be placed in the trainee’s file.

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When the resident continues to demonstrate a pattern of marginal or unsatisfactory academic performance, they will be placed on academic probation as specified in the Institutional Manual. A Radiology Graduate Medical Education Committee will meet to discuss the outcome of the probation, and may recommend: Removal from probation with a return to good academic standing; continued probation with new or remaining deficiencies sited; Non-promotion to the next level of training; Contract non-renewal and/or dismissal.

Discipline/Dismissal for Non-Academic ReasonsDiscipline/dismissal for non-academic reasons will follow the guidelines set forth in the Institutional Policy Manual.

Grievance Procedure and Due Process Refer to the Institutional Policy Manual.

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SECTION V. GENERAL POLICIES AND PROCEDURES (Please refer to Institution Policy Manual at http://www.med.umn.edu/gme/residents/instpolicyman/home.html for Medical School Policies on the following: Academic Health Center (AHC) Student Background Study Policy; Background Study Policy and Procedure; Applicant Privacy Policy; Appointment Letter Policy and Procedure; Blood Borne Pathogen Diseases Policy; Certificate of Completion Policy; Classification and Appointment Policy; Compact for Teaching and Learning; Disability Policy; Disaster Planning Policy and Procedure; Documentation Requirements Policy; Documentation Retention Requirements for FICA Purposes Policy; Dress Code Policy; Duty Hours/On-Call Schedules; Duty Hours Policy; Duty Hours/Prioritization of On-Call Room Assignments; Effective Date for Stipends and Benefits Policy; Eligibility and Selection Policy; Essential Capacities for Matriculation, Promotion and Graduation for U of M GME Programs; Evaluation Policy; Health Insurance Portability and Accountability Act; Immunizations and Vaccinations; Immunizations: Hepatitis B Declination Form; Impaired Resident/Fellow Policy and Procedure; Licensure Policy: Life Support Certification Policy; Moonlighting Policy; National Provider Identification (NPI) Policy and Procedure; Nepotism Policy; Observer Policy; Post Call Cab Voucher Policy (UMMC-F; HCMC); Registered Same Sex Domestic Partner Policy; Release of Contact Information Policy; Residency Management Suite (RMS): Updating and Approving Assignments and Hours in the Duty Hours Module of RMS; Restrictive Covenants; Standing and Promotion Policy; Stipend Level Policy; Stipend Funding from External Organizations Policy; Supervision Policy; Training Program and/or Institution Closure or Reduction Policy; Transitional Year Policy; USMLE Step 3 Policy; Vendor Policy; Verification of Training and Summary for Credentialing Policy; Voluntary Life Insurance Procedure; Without Salary Appointment Policy ).

I NTERVENTIONAL RADIOLOGY FELLOWSHIP PROGRAM DESCRIPTION

The Interventional Radiology Fellowship is a one-year ACGME accredited program with an option for two years depending on eligibility. Full training is accomplished in one year by rotating the fellows through all the different areas of interventional radiology in the participating institutions. The second year is provided to enhance the training received in the first year and to encourage more in-depth research efforts. Four fellowship training positions have been approved. Interventional Radiology encompasses a variety of invasive diagnostic and image-guided therapeutic techniques, including all aspects of radiological diagnosis and treatment of a wide array or organs, including blood vessels, biliary ducts, urinary tract, gastrointestinal tract, as well as magnetic resonance and computed tomographic studies of blood vessels excluding the cerebral vessels. Our fellowship program offers a quality graduate medical educational experience of adequate scope and depth in all of these associated diagnostic disciplines. We offer an environment that encourages the interchange of knowledge and experience among fellows and faculty within the program and with residents, fellows and faculty in other major clinical specialties throughout the hospital.

Candidates for the Interventional Radiology Fellowship Program must have completed a Diagnostic Radiology residency program or finished two (2) years of residency training in a medical or surgical specialty or are being accepted for the DIRECT pathway.

The minimum curriculum and training requirements will be met in the first year by rotating the fellows through the UMMC IR rotation, the VAMC IR rotation and the combined UMMC/VAMC non-invasive imaging rotation; by having quarterly evaluation sessions with the fellows and an end-of-year final assessment of the fellow and the program; by daily monitoring and tutoring of the fellows by the staff during procedures and clinic visits; and by completion of competency training and didactic instruction as determined by the program.

The majority of the fellowship is spent working at the UMMC and VAMC performing invasive procedures. All fellows learn how to prepare for, complete, and then manage the follow-up for each individual procedure.

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A maximum three-month rotation through the non-invasive vascular lab provides training and background in the hemodynamics, pathophysiology and imaging of the peripheral vascular system. During this rotation, the fellows are exposed to vascular ultrasound, magnetic resonance angiography, and computed tomographic angiography. A multispecialty approach to vascular disease is taught to the fellows during this rotation and they have the opportunity to participate in the vascular surgery clinic. At this time, the fellow also collects and presents to the IR conferences specific non-invasive imaging cases in which IR has been or will be involved. Follow-up cases are also specifically presented to IR, vascular surgery, and vascular medicine in the weekly, multi-disciplinary, vascular conference that alternates between the UMMC and VAMC, and which includes discussions led by fellows and residents, to help them further understand the disease processes that are involved with vascular interventional procedures.

During the non-invasive vascular rotation months, fellows also participate weekly in the IR clinic in which they will see patients with a wide variety of oncologic and vascular and lymphatic problems. Many of the patients will have imaging or non-invasive vascular testing prior to or following a procedure, giving the fellows an opportunity to see how patients should be fully evaluated and managed both pre- and post-procedure in a clinical setting. Appropriate management strategies will be discussed with the IR staff, and further follow-up and therapeutic plans are formulated. At other times during their training, fellows will be encouraged to return as often as they can to the weekly IR clinic to see patients in which they have a special interest pre-procedurally, and, in addition, to ensure continuity of care, to see patients whom they have cared for during a complex or interesting procedure in IR.

INTERVENTIONAL RADIOLOGY PROGRAM GOALS AND OBJECTIVES

IntroductionIR, like general radiology, interacts with and encompasses patients from many

fields of medicine. This makes it very difficult to find the appropriate balance between being an “expert” and being “acceptably knowledgeable” about or “acceptably familiar and facile” with the broad range of skills and bodies of knowledge associated with the IR patients’ problems. Even though IR is undergoing a rapid transformation into a more clinically oriented subspecialty, it remains for the majority of its work a referral service that requires a large team of people who can respond to the emergent and routine referrals in a timely and patient centered fashion. This means that anyone who plans a career in IR must be someone who has the ability to be a team builder and communicate effectively and honestly with their team members and the full spectrum of referring clinicians.

Goals1. IR is only a 1year fellowship. Since this is clearly not enough time to allow a person to become expert with all of the procedures and information pertinent to the broad range of IR patients, the overriding goal must be to provide the fellow with the appropriate attitude and basic skills so that they will become a lifelong learner with a clear patient-centered focus, and the ability to approach care related problems as a chance for personal and system improvement.

The remaining goals are as follows:2. To provide the fellow with adequate knowledge of imaging and the necessary procedural skills so that they are technically competent enough to safely and independently practice IR. However, they must additionally be given the understanding that, as with any knowledge and skill set, they must retain the capacity and desire to learn about new developments and incorporate them into their practice.

3. To make the fellow medically knowledgeable about the disease processes relevant to IR patients and procedures with greater knowledge about specific diseases for which they become the primary physician such as vascular problems including vascular

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malformations.

4. To help the fellow become a good teacher since they will spend much of their professional life educating others about the procedures they can perform and how they fit into the care plan for patients.

5. To give the fellow the knowledge and desire to participate in research throughout their career, whether that is in a private or academic setting.

6. To help the fellow understand the importance of and give them the tools to become a good team builder.

7. To help the fellow understand the position of the IR team in the health care system. 8. To help the fellow develop techniques to communicate effectively and sensitively with patients, families and other medical personnel.

ObjectivesIn order to align these with the competency model, the objectives will be organized under the competency headings.A - Medical and Imaging Knowledge

ImagingUpon completion of the program, fellows will have knowledge of the following:1. the basic principles of imaging and imaging physics including radiation biology

and safety, and the physics of fluoroscopy, computed tomography, ultrasonography,

and MR imaging. 2. the principles of radiographic and cross-sectional imaging (sonographic, CT and MR) as they are applied in the performance of interventional procedures.

3. the principles of cross-sectional imaging, and the principles of physiologic monitoring and evaluation in the diagnosis of vascular problems especially the

use of CTA, MRA and duplex Doppler ultrasound. Knowledge of indications for CTA of the blood vessels (excluding the brain). While on the non-invasive imaging rotation, the fellow should be able to do the following:

Protocol and supervise all MRAs and CTAs.

Understand factors that affect CTA imaging and image quality and the differences

in the different types of CT scanners, protocols and contrast agents. Understand factors that affect MRA imaging and image quality i.e. field strength, coils, open vs. closed systems, NEX, contrast dose and timing, etc.

MedicalLearn and apply the principles of conscious sedation

Learn the Society of Interventional Radiology guidelines and standards for procedure

performance (both diagnostic and therapeutic).Learn the basic medical knowledge pertinent to the primary patient groups and

problems treated by IR including the following:Oncology

Solid tumor oncologyGynecologic oncology

Vascular diseaseArterial pathology, especially atherosclerosisVenous diseases, especially

Thrombosis

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Thrombolysis and anticoagulationVenous access

TransplantationSolid organBone marrow

Renal obstructionGastrointestinal and biliary obstructionHemorrhage

TraumaNon-traumatic such as hemoptysis and GI bleeding

HemodialysisPain controlPediatric intervention including specifically the following:

Knowledge of differences between adult and pediatric anatomy, pathophysiology and development, as applied to interventional radiology.

Recognize normal pediatric anatomy, normal variants and congenital anomalies.

Understand indications for pediatric interventional imaging and appropriateness of the various imaging modalities.

Attend all IR staff and IR guest lecturer didactic sessionsAttend all Radiology Department guest lecturesAttend all special lectures in other departments pertinent to the

diseases and IR patients mentioned above Attend all multidisciplinary conferences with IR participationDemonstrate a thorough understanding of the medical issues

pertinent to the patients they will be treating on any given day during the patient care meeting at the start of the day

B - Patient CarePerform competently all procedures considered essential in the

primary patient groups treated by IR includingthe following:

Biopsy using CT, MRI, ultrasound, and fluoroscopyTumor biopsySolid organ biopsy including transplants

PercutaneousTransvenous

Drainage of abnormal fluid collections using CT, MRI,ultrasound, and fluoroscopy

Diagnostic arteriographyDiagnostic venographyArterial intervention

Angioplasty, atherectomy, stenting, stent-graft placement,mechanical thrombectomy, and thrombolysis

Venous interventionAngioplasty, stenting, stent-graft placement, mechanicalthrombectomy, and thrombolysis

Embolization, ablation and sclerotherapyTumorBleedingVascular malformationsVenous incompetenceCysts

Venous access, all types

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Percutaneous nephrostomyDilation and stent placement and managementStone removal

Percutaneous biliary drainageDilation and stent placement and managementStone removal

Gastrostomy and gastrojejunostomy tube placementEnteral balloon dilation and stenting

Vertebroplasty and kyphoplastyPain management injection techniques

Demonstrate in morning patient care meetings that they canaccomplish the following steps in the care of their IRpatients:Gather essential and accurate informationDiscuss difficult cases with referring clinicians in other

disciplines to ensure that the care plan is firmlypatient-focused

Make informed decisions based on up-to-date scientificevidence and sound clinical judgment

Use information technology to support the abovedecisions

Demonstrate during and following the procedure that they canaccomplish the following steps in the care of their IRpatients:Perform procedures in such a way as to prevent health

problems with complication rates within theguidelines established by the SIR

Communicate effectively and demonstrate caring andrespectful behaviors when interacting with patientsand their families

Develop and carry out patient management plans for thepatients admitted to the IR service

Pass the IR CAQ

C - Practice Based Learning and ImprovementAttend the complications conferences and analyze their experience

and the experience of others in IR in such a way as to fosterimprovement in patient care

Participate in journal conference and demonstrateknowledge of study designs and statistical methods

Participate in local conferences and didactic sessionsrelated to their patients’ health problems

Use information technology to develop literature support fordecisions made in the care of patients and slides discussingpatient care related decisions in conferences

Develop the research and academic skills necessary to design, develop and execute

research projects appropriate to their patients and interests Participate in interdisciplinary research groupsServe as operations manager for a faculty research project, offering

guidance and technical support (eg, research design, statistical

analysis) engaging residents and/or medical students in scholarly

activitiesDevelop at least one individual research project (plan, organize,

implement,and, if possible, complete)

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Meet with mentors regularly to discuss research projects

D - Systems Based PracticeDemonstrate with at least one case example per quarter that they

have acted as a patient advocate assisting the patient orfamily deal with a patient relations, discharge difficulty orother system related complexity.

Discussed at least once per quarter with an industry representativeand the IR inventory specialist a use of equipment thatcould potentially offer a possibility for more cost effectivehealth care without compromising quality of care

Attend all GME sponsored lectures on systems based practiceComplete U of MN institutional requirements to function as Principal

Investigator (PI)FIRST (Fostering Integrity in Research, Scholarship and Teaching)

http://www.research.umn.edu/first/EdReqs.htmPart 1 (available only as an in-person classroom course)

Social Responsibility & Reporting Misconduct including

History and Values Relating to Research and Scholarship

Authorship, Plagiarism & Peer Review Research Data Management

Part 2 (available both in-person and online formats)Fiscal ResponsibilitiesIntellectual Property (online)Conflict of Interest (online)

Protecting Human Subjectshttp://www.research.umn.edu/first/HumanSubjects.htm

Other courses as needed: i.e. animal subjects, environmental health and

safety

E – ProfessionalismDemonstrate sensitivity and responsiveness to patients’ culture,

age, gender and disabilitiesDemonstrate respect, compassion and integrity for the skills and

efforts of the technologists and nurses of the IR teamDemonstrate the qualities of a dedicated IR physician including punctuality,

thoroughness, clarity, and completeness of notes and dictations.Attend all GME sponsored lectures on professionalism and ethics

F - Interpersonal and Communication SkillsCommunicate 100% of all significant procedure results by personal

phone call to a member of the referring clinical teamCommunicate procedure results to the family accompanying the

patient in 100% of the cases where a family member ispresent.

Demonstrate that during the patient evaluation and consentprocess, that they can create and then sustain through theprocedure and follow-up care a trusting and ethicallysound relationship with patients

See at least one patient for whom they have been the primaryoperator back in clinic per quarter

Work with the IR nurses and techs as an effective leader of the IRcare team

Attend all GME sponsored lectures on communication skills

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Demonstrate that they can communicate their knowledge to medical students and

residents as an effective teacher in conferences and during cases

Interventional Radiology Didactic Lecture CurriculumIn order to provide the basic core information to assist fellows in the development of the knowledge base necessary to achieve the competency objectives, the following lectures will be provided to the fellows by the IR or other UMMC staff. In addition to those listed, other topics may be covered as they become available from UMMC staff during the year. In addition, some of the lecture topics will be supplemented by or based entirely on lectures or other educational sources associated with institutional GME activities, national meetings, local meetings or special lectures, and medical educational websites such as those associated with the RSNA, SIR, and ACR.

Patient Workup and followupEmergencies: Hypotension and HemorrhageHemostasisPAD: Diagnosis and Management Arteriography and intervention: PeripheralArteriography and intervention: RenalArteriography and intervention: Non-renal visceralArteriography and intervention: Arch/CarotidsArteriography and intervention: PulmonaryArteriography and intervention: BronchialThrombosis and thrombolysis: ArterialArterial embolotherapy and chemoembolization Uterine fibroid embolizationVenography and ambulatory venous pressuresSpermatic vein embolization and sclerotherapyDVT diagnosis and managementChronic venous insufficiency and interventionTIPS AVM treatment and managementSclerotherapyVasculitisTraumaTreating failed or failing hemodialysis accessVenous access creation and managementUrologic proceduresUreteral stent managementBiliary proceduresAbscess/fluid drainage and managementEnteric accessTumor ablation, principles and practice of RFA, and other ablation techniquesNoninvasive vascular imaging: MRA/CTANoninvasive vascular evaluation: LEADSLung biopsyEthics: Palliation, access issuesProcedural: introduction to equipment; tips, and techniquesRadiation safety and IRCommonly used drugs: doses, dangersConscious sedation, principles and practicesPediatric tumorsPrinciples of bariatric surgery and management of complicationsSolid organ transplant patients, medications and problemsSolid organ transplant patients, managing complicationsBone marrow transplant, update on principles and problemsLiver tumors

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Chronic lung diseaseChronic renal disease, performing a renal biopsyKyphoplasty and vertebroplastyDiagnosis and management of osteoporosisTreating diabetes in the hospitalized patientPhysiology and indications for magnesiumAnticoagulation: the basicsApplication of interventional radiology in pediatric intensive carePediatric sedationTreatment of line and site infections

I NTERVENTIONAL R ADIOLOGY C ORE R OTATIONS The fellows in IR will have the following rotations:

IR UMMCIR VAMCIR HCMCNon-invasive vascular imaging at both the UMMC and VAMC

The time spent on these rotations will vary slightly based on the number of fellows, the previous

experience or needs of the fellow, and the needs of the program. If there are 4 fellows, which is the optimal and approved number, each fellow will spend 6 months in IR at the UMMC, 3 months in IR at the VAMC, and 3 months in non-invasive imaging.

I NTERVENTIONAL R ADIOLOGY F ELLOW C LINICAL R ESPONSIBILITIES

All patients are seen prior to the performance of any procedure. The procedure is explained to the patient and/or family in detail, a physical examination is done, laboratory values are checked, necessary medications are prescribed, and consent is obtained. Most of the patients are seen by either a resident or a fellow, usually working independently but occasionally working as a team, particularly on more difficult cases. In addition, the pre-procedure consent may be obtained on occasion by a team consisting of a staff member if the case is exceptionally difficult or politically troublesome. Almost all cases are discussed with a staff person prior to the resident or fellow leaving to obtain consent and do the preliminary work-up. As fellows become more proficient in their understanding of cases and demonstrate greater medical and procedural expertise, they are allowed to see patients without first discussing them with a staff person and in some cases, to assign residents to obtain consents. If any question or problem arises during the patient work-up the fellows are encouraged to call any of the staff available to solve the problem.

Intra-procedure: Most cases are performed by a resident and a fellow working under the direct supervision of a staff person who is in the room or immediate vicinity, monitoring the progress of the case continuously and discussing the case and any technical or management issues with them. In many cases, the staff person may also be scrubbed in either to perform the case or demonstrate more complex techniques. As fellows become more comfortable with the technical aspects of procedures, they are allowed to do much of the resident teaching and switch from being the primary operator, to being the assistant for the resident who is assigned as the primary operator. Some extremely routine cases may be supervised by or performed by a fellow who is either at the end of their first year or in their second year. In such instances, after appropriate discussion with an IR staff person, the staff may observe the fellow’s performance and management decisions without making continuous comments or suggestions. The degree to which fellows and residents are allowed to work without a staff person scrubbed in with them is dependent upon careful ongoing assessment of their capabilities by the staff people who work with them on a daily basis.

Post-procedure: Care is undertaken under the supervision of a staff interventional radiologist. This is coordinated with our nurse clinicians, nurse practitioners, fellows, and residents. Follow-up procedures and examinations are discussed with the staff interventional

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radiologist. During these discussions further teaching regarding patient care and follow-up for the procedures are discussed with the nurse clinicians and nurse practitioners, fellows, and residents on the service. In addition, patients are occasionally admitted to the IR inpatient service. The fellows and residents, under the supervision of a staff physician, admit and manage these patients. Daily rounds are done on these patients until their discharge. Appropriate follow-up is also arranged when necessary.

Fellows, residents and staff involved in any and every procedure are responsible for making sure that results and plans have been appropriately communicated to the referring physicians and relatives.

All patients are entered in a computerized database to help in future care and follow-up. Accurate determination of the cases performed by the residents and fellows, which becomes the trainee’s case log, is maintained in the computer database. Every complication is also reported in writing in the computer database by the participating staff, fellow, and/or resident.

All complications entered into the database are reviewed and discussed every other week in the IR complications conference. In addition, every complication encountered during an IR procedure is thoroughly reviewed and discussed by the staff, fellow and resident immediately after the procedure. The discussion is directed toward prevention of further occurrences of this complication.

SUPERVISION/GRADED RESPONSIBILITY The fellow’s participation is one of active participation under direct supervision of full-time staff. The teaching staff determines the level of responsibility given to each fellow. Fellows receive direct supervision with graded degrees of responsibility relating to their level of training. However, at all times, final responsibility for patient care resides with the full-time staff.

The following are the guidelines for determining the “lines of supervision” for the care of patients,

and the “criteria for progression of responsibilities” (advancement) for residents and fellows on

the Interventional Radiology service:

Initial experience is by first-hand direct observation of procedures performed by faculty. The progression of residents and fellows into the role of primary operator, in the beginning assisted by faculty, and then later observed by faculty, will be based on demonstration of sufficient technical expertise and judgment, and the degree of difficulty of the case. Depending on the outcome of the quarterly evaluation, fellows may be allowed to supervise and assist residents in the less complex procedures beginning in the second quarter of the fellowship year. Upper-level residents (3rd and 4th year residents or residents in PGY 4 and PGY 5 status) may, after the first week of the rotation, perform simple procedures in their entirety provided that an attending physician is present in the room and they have demonstrated satisfactory progress.

In order for a resident or fellow to be granted any increase in responsibility for the performance of or participation in a procedure, they must demonstrate detailed familiarity with the technical aspects of the procedure and be able to describe the equipment and the sequence of steps in the procedure. Residents and fellows who are able to ask discerning, proactive questions to avoid potential complications will be advanced faster than those who tend toward passive observation. A fellow or upper level resident should be able to perform the following procedures without a staff person scrubbed in to assist them, after they have performed at a minimum the number of cases indicated: enteric access (5 cases),fluid drainage (5 cases), biopsy of solid organ/mass (10 cases),

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tunneled and non-tunneled central venous access (10 cases), diagnostic angiography (arteriography and venography) including ultrasound and fluoroscopy guided

arterial puncture and arterial closure (10 cases). Complication rates should not be outside the expected ranges describe by the Society of Interventional Radiology. Fellows are expected to make complex cases a priority, including all arterial interventions, device deployments beyond drains and catheters (i.e stents, stent-grafts, and embolizations), thrombolysis cases, GU and hepatobiliary cases, enteric access, etc.

Representative common procedures are discussed below in the following format for residents and fellows:

1) Pre-procedure considerations2) Technical aspects of each procedure and complications3) Post-procedure management

Representative procedures:1) Percutaneous abscess/fluid drainage2) Central venous access3) Angiography4) Enteric access

1) Percutaneous abscess/fluid drainageResidents will be advanced in responsibility based on their demonstration of the following:

a) Knowledge of the appropriate indications and contraindications for drainage, and the ability to recognize patients for whom sedation is a greater risk and respond accordingly;b) Understanding of anatomy and pathology to discern how/if a collection is amenable to percutaneous drainage;c) Ability to recognize and treat underlying coagulopathies;d) Ability to obtain informed consent: note this is not simply permission but a meaningful

discussion of risks, benefits, and alternatives, and demonstration of the capability to establish a relationship with the patient or the patient’s representative;

e) Ability to access a fluid collection safely and accurately with CT, US, and/or fluoroscopic guidance with no breaks in sterile technique and attention to minimizing radiation dose;f) Ability to properly deploy and anchor a drain;g) Ability to document appropriately with a complete and accurate dictation and thorough and understandable post-procedure notes/orders with appropriate follow-up patient care;h) Ability to communicate findings and outcomes to the patient, relatives, and

referring service.

Fellows:In addition to the above, fellows should be able to recognize and treat complications

from errant punctures, and kinked or misplaced catheters or wires; diagnose and manage decreased drain outputs; and manage all patient follow-up care. They should be capable of handling conscious sedation decisions and be comfortable with all patient monitoring devices and their implications for patient care.

2) Central Venous access:Residents will be advanced in responsibility based on their demonstration of the following:

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a) Ability to understand the differences in type of access and reasons for a PICC, a tunneled line, and a port;b) Demonstrate that they adequately know and understand the patient’s history to be able to accurately assess any access issues (positive blood cultures, known central occlusions, etc.);c) Ability to recognize and treat underlying coagulopathies;d) Ability to place the catheter in an appropriate position, lock and secure the catheter as appropriate, and dress the wound;e) Ability to document their procedure and care decisions appropriately with dictation and post- procedure notes and orders.

Fellows:In addition to the above, fellows should be able to recognize and treat complications

from errant punctures and kinked or misplaced catheters and wires; diagnose and manage poorly functioning access; and manage all patient follow-up care. They should be capable of handling conscious sedation decisions and be comfortable with all patient monitoring devices and their implications for patient care.

3) Angiography:Residents will be advanced in responsibility based on their demonstration of the following:

a) Ability to understand the rationale for the procedure and any contraindications;b) Ability to manage renal insufficiency prior to procedure;c) Ability to recognize and treat underlying coagulopathies;d) Ability to obtain groin arterial access with Seldinger technique using either ultrasound

or palpation for guidance, and place a flush catheter in the abdominal aorta;e) Demonstrate knowledge of the appropriate injection rates and patient positioning;f) Ability to safely remove catheters and sheaths and obtain hemostasis with graded

manual compression;g) Ability to document their procedure and care decisions appropriately with dictation

and post-procedure notes and orders.

Fellows:In addition to the above, fellows should be able to recognize and treat complications

from errant punctures, kinked or misplaced catheters and wires, dissection, or embolization. They should be able to perform up to third order selective catheterizations in conjunction with device deployment or embolization procedures. They should also be familiar with alternate access sites, closure devices and appropriate anticoagulation and thrombolytic medications. They should be capable of handling conscious sedation decisions and be comfortable with all patient monitoring devices and their implications for patient care.4) Enteric Access:Residents will be advanced in responsibility based on their demonstration of the following:

a) Appropriate understanding of the rationale for the procedure;b) Ability to ensure proper device selection;c) Ability to assess appropriate access using pre-procedure imaging;d) Ability to recognize and treat underlying coagulopathies;e) Ability to deploy gastropexy sutures and place tube properly;f) Ability to document their procedure and care decisions appropriately with dictation and

post-procedure notes and orders.

Fellows:In addition to the above, fellows should be able to recognize and treat complications

from errant punctures, kinked or misplaced catheters and wires, and any malpositioning of the enteric tube. They should also be able to diagnose and treat bleeding complications and infection at the ostomy site. They should be capable of handling conscious sedation

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decisions and be comfortable with all patient monitoring devices and their implications for patient care.

5) Simple proceduresThere are some procedures that are of a sufficiently routine nature that the critical part of the case is in fact the discussion prior to the case. After sufficient discussion and observation of at least one case, fellows and even junior house staff (i.e. first and second-year residents) are expected to be able to perform such procedures shortly after beginning their first rotation on the interventional service. The discussion may incorporate elements such as patient selection, appropriateness of the procedure, judgment regarding when to request assistance if unanticipated questions or difficulties are encountered, and a review of straightforward technical details. Examples of these cases include but are not limited to line removal (tunneled and non-tunneled central venous catheters), abscess or fluid drain removal, and T-tac removal. Staff will be available to assist if needed but will not necessarily be physically present in the room.

For a more comprehensive discussion of the IR curriculum, please see the extensive (45 page) document on the SIR website: http://sirweb.org/gradEdu/FellowshipCurriculum.pdf. A copy is available from the fellowship program director if the web site is not accessible.

PROGRAM REQUIREMENTS

All fellows are governed by the requirements in both the Institutional and Program Manual. This

program is accredited by the Accreditation Council for Graduate Medical Education and follows the

requirements set forth by the ACGME. To view these requirements, go to http://www.acgme.org.

The Graduate Medical Education Committee, chaired by the Program Director, evaluates the progress of the fellows, and makes recommendations for advancement or disciplinary actions. The Program Director with advice from Graduate Medical Education Committee members, determines candidates for admission to the training program, fellows’ progress in the program, and fellows satisfactory completion of graduation requirements.

Fellows are expected to successfully complete their monthly rotations.

Fellows are required to comply in a timely manner with administrative directives including those from the Program Coordinator. This includes, but not limited to:

Proper notification of all time away Weekly submission of duty hours in RMS Record conference attendance in RMS Conference Module for UMMC Conferences Prompt completion of RMS evaluations Reading/Studying during regular work hours – must be patient care related Regular attendance at conferences is a mandatory requirement of this program

and trainees are required to document their attendance at appropriate conferences at their institution on days they are at work. Only those on call, post-call, ill, on leave, will be considered to have excused absences.

Fellows are required to attend Grand Rounds and Core Curriculum Conferences at the University on days they are at work, regardless of which institution they are working at.

TRAINING/GRADUATION REQUIREMENTS This program is adheres to the training requirements set forth by the American Board of Radiology and the Accreditation Council for Graduate Medical Education. These requirements can be reviewed at http://www.theabr.org and http://www.acgme.org

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Graduation certificates are awarded to fellows who successfully complete all of the Program requirements, have shown satisfactory progress toward the competent, independent practice of Pediatric Radiology, and demonstrate professional and personal attributes dedicated to the life-long learning process associated with the practice of medicine.

ACGME CORE COMPETENCIES

All University of Minnesota Medical School Residency/Fellowship training programs define the specific knowledge, skills, attitudes, and educational experiences required by the ACGME/RRC to ensure its residents/fellows demonstrate the following:

1) Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

2) Medical knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

3) Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.

4) Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals.

5) Professionalism , as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

6) Systems-based practice , as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value.

DUTY HOURS

Duty hours are defined as all clinical and academic activities related to the training program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours DO NOT include reading and preparation time spent away from the duty site.

- Duty hours are limited to eighty (80) hours per week, averaged over a 4-week period, inclusive of all in-house call activities.

- Fellows are provided with one (1) day in seven (7) free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.

- The training program provides adequate time for rest and personal activities, which consists of a 10-hour time period provided between all daily duty periods and after in-house call.

- Fellows track their duty hours through the RMS System. The duty hours reports are then reviewed by the Program Coordinator for any violations.

- Violators will be notified and required to submit written documentation as to why violation occurred.

Federal regulations mandates that GME programs account for all fellow hours worked in order to maintain Medical Education funding. In addition to these federal regulations, ACGME also mandates programs monitor duty hours to ensure compliance with duty hour requirements. This means that fellows must complete an online timecard of their hours worked in order to be compliant with these mandates and continue funding, accreditation, and flexibility of the program.

Duty hour violations are prohibited. Fellows are responsible for making the program aware of impending violations before they occur.

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RMS – RESIDENCY MANAGEMENT SUITE

The Minnesota Medical Council of Graduate Medical Education mandates the University of Minnesota use RMS to track fellow duty hours. The department also uses RMS as an evaluation tool.

DUTY HOUR APPROVAL POLICY & PROCEDUREAll activities performed by residents during their rotations are documented in an online system called Residency Management Suite (RMS). The data held within RMS is used to document and reconcile payments with the institutions where the fellows/residents rotate. Fellows are required to enter their duty hours into RMS weekly and review for accuracy.

Fellows are responsible for making any changes such as; start time, duration, applying activities they participated in and indicating those activities they did not participate in with “Did Not Work”.

Maintaining your duty hours is not only a GME requirement it is also a requirement for the completion of your degree.

Note: Failure to ensure accuracy of your rotation activities will be considered an act of Medicare fraud.

Duty hours are to be entered by 7AM on the first working day of the month. We are granting you the weekend now to get things in order.

All fixes indentified by Program Coordinator must be corrected by the following morning.

If the above do not occur:

Residents and Fellows on a U of M rotation will have their parking privileges revoked beginning the next day and will be in effect until the residency/fellowship office has cleared you.

Fellows will have a letter placed in their permanent file reflecting a lack of professionalism if pattern continues.

Use of the New Innovations Residency Management Suite (RMS)Logging into RMS:

Use your browser to go to www.new-innov.com/login. Internet Explorer is the preferred browser.

Enter MMCGME for the Institution ID.

Enter your User Name and Password in the appropriate boxes.

Make sure that you have arrived at your Welcome Page. You should see your Department name in the upper left section of the screen, and your User Name will be listed just below that.

Duty Hours – Entry and Approval or Modification of Already Entered HoursA) Entry of New Duty Hours

1. From the Main Menu, select Duty Hours.

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2. Select the Add Duty Hours link and ensure that Graphical entry is selected. Select the date you wish to enter hours for and click Continue. 

3. Choose an Assignment from the drop down menu and “paint” in your hours by holding your left mouse button down and dragging across the grid. Click Save regularly to avoid loosing the hours entered.

B) Approval or Modification of Already Entered Hours

1. Select the Approve Existing Hours link. 

   2. If necessary, enter a date range to restrict the unapproved or conflicting logged Duty

Hours to display, and then click the Update Table button. 

3. Where appropriate, place a check in one or more of the checkboxes located to the left of the entries. Then click the Approve Selected Entries or the Did Not Work button. 

Note: A red asterisk (*) indicates that the entry conflicts with an existing entry (time periods overlap).

 Note: Text in bold red indicates the entry has caused a Duty Hour rule exception.

 Note: Hours will not be automatically approved if they were logged for future dates or times, if they conflict with existing logged hours, or if they trigger a Duty Hour exception. Hours that trigger a Duty Hour exception CAN be approved, although you may want to enter an explanation in the Comment box. Conflicting Duty Hour entries must be resolved before the entry can be successfully approved. Duty hours logged for any time in the future cannot be approved. 

Tip: Click the Details link to the far right of a entry to see more information about the entry (see second screenshot below).

 Tip: Click the Comments link to view, edit, or delete any comments that are associated with the logged hour entry OR to add another (see third screenshot below). 

ON-CALL ACTIVITIES

The objective of on-call and night float activities is to provide residents with emergency radiology experience, and is scheduled by the section after approval of the Fellowship Program Director and Chairman.

Radiology fellows are assigned call at UMMC and VAMC. Call averages no more than one-in-four, but can change on an as-needed basis. Scheduling of the fellows for call is the direct responsibility of the section with Program Director approval.

ON-CALL ROOMS

An on-call room within the Department of Radiology is available to residents taking departmental call or night float at both UMMC and HCMC, where fellows receive their in-house on-call experience. Any questions or concerns regarding departmental on-call rooms should be directed to your Program Director.

On-call fellows are also eligible to use one of eighteen (18) Mayo Building call rooms provided by UMMC. All rooms have punch code security access changed daily, and a security monitor on duty daily from 2:00 PM – 7:00 AM. All rooms have a desk, television, radio clocks and air conditioning.Check-in can only occur during designated check-in hours: 2:00 PM – 7:00 AM.

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- Go to the check-in desk located in the Resident Lounge (Mayo C-496). The check-in desk is staffed by a security monitor during set hours seven (7) days/week and will require you to present your ID badge.

- The security monitor will assign you a room, the room access code, and the locker room and lounge access codes.

- All individuals must be out of their room by 8:00 AM. Housekeeping will begin cleaning by 7:00 AM. If you wish to sleep past 7:00 or 8:00 AM, make sure your “Do Not Disturb” sign is indicated on your door.

SUPPORT SERVICES

A full range of patient support services are provided in a manner appropriate to and consistent with educational objectives and patient care. These include but are not limited to Care Management Services, Cardiopulmonary Services, Employee Health Service, Health Information Management, Infection Control, Laboratory Medicine and Pathology, Nursing Administration, Nutrition Services, Patient Relations, Patient Transport, Pharmacy Services, Radiology Film File Services, Rehabilitation Services, Security Services, Social Services, Spiritual Health Services, and Shuttle Service between the Riverside and University campuses.

LABORATORY / PATHOLOGY / RADIOLOGY SERVICES

Federal and state regulations and regulatory agencies mandate competency validation for testing personnel (including physicians), documentation, quality assurance, quality control, etc. The regulations cover hospitals, clinics, physicians’ offices, nursing homes, and any site where testing is performed. Testing performed by physicians, practitioners, nursing staff, and laboratorians must meet regulatory guidelines. Failure to comply with the mandates can lead to suspension, revocation, or limitation of certification and denial of reimbursement.

MEDICAL RECORDS - HEALTH INFORMATION MANAGEMENT

A medical record system that documents the course of each patient’s illness and care is available at all times to support quality patient care, the education of residents, quality assurance activities, and provide a resource for scholarly activity. Additionally a provision of information systems is made for timely retrieval of medical records and radiologic information. To access please contact: UMMC Health Information Management Office at 612-626-3535.

SECURITY / SAFETY

Security and personal safety measures are provided to fellows at all locations including but not limited to parking facilities, on-call quarters, hospital and institutional grounds, and related clinical facilities (e.g., medical office buildings).

UMMCFairviewCampus

UMMCRiverside Campus

HCMC VAMCUniversityofMinnesota

SECURITY

612-672-4544

612-672-4544

612-873-3232

612-467-2007

612-624-9255

RADIATION BADGES

Radiation badges must be worn in controlled radiation areas under penalty of State law. You may be fined by the State Health Department if found not wearing a badge during an inspection.

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New badges will be placed in your mailbox at the institution to which you are assigned on the first working day of the month. Always keep your old badges until you get a replacement. Badges from the previous month must be returned to your mailbox by the 8th of each month.

Under University policy, late badges will result in a fine of $50 per badge (unless replacement badges have not arrived in time to make the exchange). The amount of the fine will be deducted from your travel fund; if adequate funds do not remain, the fellow will be billed for the amount owed. Fellows who plan to be away during the exchange period are required to make arrangements with someone to exchange their badges in their absence.

Lost or stolen badges must be reported to Pamela Hansen at 612-626-6638 or hanse032@umn.edu.

MOONLIGHTING

This policy does not acknowledge in any way, any departmental acknowledgement of the fellow’s ability to satisfactorily perform any moonlighting activities. Malpractice insurance is the responsibility of the fellow involved. Accreditation is up to the party hiring the fellow. Fellows are not required to engage in moonlighting.

Because fellowship education is a full-time endeavor, moonlighting must not interfere with the ability of the fellow to achieve the goals and objectives of the educational program.

Fellows are required to notify the Program Director of their moonlighting activities. They shall email the Program Coordinator the dates, times and locations of all moonlighting activities and will become a part of the fellows file.

Moonlighting activities will not be allowed to conflict with the scheduled and unscheduled time demands of the educational program and its facility.

The fellow’s performance will be monitored for the effect of these activities upon performance and that adverse effects may lead to withdrawal of permission.

Internal moonlighting must be counted toward the 80-hour weekly limit on duty hours.

Fellows on J1 visas are NOT permitted to be employed outside the fellowship program.

A fellow on an H-1B visa wishing to moonlight must obtain a separate H1-B visa for each facility where the fellow works outside the training program.

STEPS IN EVALUATION PROCESS

The Graduate Medical Education Committee, a faculty committee of Department of Diagnostic Radiology, has the responsibility to evaluate candidates for admission to the training program, to evaluate trainees in its programs, to promote those who are progressing satisfactorily and, ultimately, to make recommendations that they have met the criteria established by the faculty for completion of the Program.

The Graduate Medical Education Committee shall meet specifically at least two times per year for the purpose of evaluating the progress of each resident and fellow, to make recommendations for evaluating their progress and to make recommendations for advancement. These meetings should be in the fall and spring.

The faculty members and Program Director in IR prepare quarterly evaluations of each IR fellow’s progress. This is accomplished both via a paperless and secured web-based reporting system (RMS) and a quarterly interview meeting. RMS evaluations are accessible to fellows on-line. Fellows also evaluate faculty members and their rotations at the end of each quarter using the same two mechanisms.

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Fellows seeking confidentiality may discuss their concerns with the Department Chair or submit a written statement anonymously via one of the department secretaries.

- Monthly and 360 Evaluations: At the end of each clinical rotation, an evaluation of the fellow’s progress is prepared by the faculty member(s) in that area. This is done via a RMS. Evaluations are accessible to fellows on-line. Fellows also evaluate their rotations at the end of each clinical rotation and faculty twice annually.

EVALUATION SYSTEM - ELECTRONIC

This Program has integrated a web-based electronic evaluation system. Evaluations both of and by fellows are essential parts of maintaining our status as an accredited fellowship program and producing superior fellow-physicians. While traditional paper-based systems allow for simple data tracking, they do not provide an easy means for improving the quality of the program. The information obtained from the analysis of evaluation data is instrumental in objectively assessing the quality of all aspects of the fellowship program and for identifying and continuously monitoring areas for improvement.

RMS is a completely web-based computer system that allows us all to enter evaluations, receive rapid feedback, view reports, and compare teaching performance with other programs. The system is highly secure and flexible. Faculty and trainees are expected to complete evaluations on a monthly basis.

The web address for RMS is https://www.new-innov.com. If you experience any problems with logging in, please contact Zalika Muskat, the Program Coordinator at 612-626-5388.

COMPLETING EVALUATIONS IN RMS

• Log into RMS• Enter your User ID & password – Click “login”• Click “continue”• Under the notifications box you will see the number of evaluations you have pending

completion. Click the text that reads “complete them”. • Click the “evaluate” link next to the evaluation you wish to complete; this will bring you

to the evaluation.• NOTE: If you have not worked with the faculty - place a check mark in the box and click

“submit selected evaluation as NET”.

1. Login to RMS. From the Main Menu, select Evaluations or click the link in your Notifications box on your Welcome Page.

2. Select the evaluations you wish to complete from the list. For evaluations where you did not spend enough time with the person to warrant an evaluation, place a check mark in the box and click NET.

3. To view your evaluations select Evaluations from the main menu and click View Completed Evaluations.

MONITORING OF RESIDENT WELL-BEING

Both the Program Director and faculty are sensitive to the need for timely provision of confidential counseling and psychological support services to the fellows.

Fellows feeling fatigued or stressed are encouraged to discuss their concerns with the Program Director, or to contact the (RAP) Resident Assistance Program at 651-430-3383 or 1-800-632-7643, especially if unable to provide safe patient care.

ACLS/BLS/PALS CERTIFICATION REQUIREMENTS

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BLS – All residents must remain current on their Basic Life Support Training. ACLS – It is recommended that residents maintain Advanced Life Support Training

Travel

The Department may cover up to three days of expenses for fellows presenting at national meetings. Individuals traveling on University business are covered under the Worldwide Travel Accident Policy, providing they have obtained permission to travel before travel begins.

Requests to travel are made via the University’s Travel Authorization form. This form can be obtained from the Travel Services website.

BEFORE THE TRIP :1. Submit complete conference registration form to Program Coordinator along with

department approval documentation for processing.2. Submit proposed flight plan Program Coordinator for processing.3. Fellow is responsible for making travel arrangements.

AFTER THE TRIP: 1. Receipts are required for reimbursements of $25 and above (accept for Per Diem

meals).2. Gather all receipts and submit to Program Coordinator for processing reimbursement. Program Coordinator will contact fellow when the University Employee Reimbursement Form is ready for their signature.

LIBRARIES

INSTITUTIONAL LIBRARIES University of Minnesota Biomedical Library (Diehl Hall)

Hours of operation:Monday through Friday: 7:00 AM – 12:00 AMSaturday: 8:00 AM – 8:00 PMSunday: 12:00 PM – 12:00 AM

Veterans Affairs Medical CenterHours of operation:

Monday through Friday: 8:00 AM – 4:30 PMAccessible with VAMC identification badge 24 hours per day, 7 days per week

DEPARTMENTAL LIBRARIES University of Minnesota Medical Center, Fairview Radiology Department

Eugene Gedgaudas Learning Center, Mayo – Room B-218Hours of operation:

Accessible via combination lock 24 hours per day, 7 days per weekIn addition to the departmental library, there are subspecialty reference books and online access in each reading room.

Teaching Medical Students

Fellows are an essential part of the teaching of medical students. It is critical that any fellow who supervises or teaches medical students must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation. Therefore, we’ve included in this manual the URL to the objectives for the Clerkship(s) specific to our Department as well as the overall Educational Program Objectives.

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Educational Program ObjectivesUniversity of Minnesota Medical School

Graduates of the University of Minnesota Medical School should be able to:OBJECTIVE OUTCOME MEASURES ACGME ESSENTIAL

COMPETENCY1.        Demonstrate mastery of key

concepts and principles in the basic sciences and clinical disciplines that are the basis of current and future medical practice.

   USMLE Steps 1 and 2   Year 1 and 2 course

performance, based on standardized examinations

   Clinical rotation performance   Feedback from residency

directors

Medical Knowledge

2.        Demonstrate mastery of key concepts and principles of other sciences and humanities that apply to current and future medical practice, including epidemiology, biostatistics, healthcare delivery and finance, ethics, human behavior, nutrition, preventive medicine, and the cultural contexts of medical care.

   USMLE Steps 1 and 2   Course performance (esp. in

Physician and Society, Nutrition, and Human Behavior at TC campus; Medical Sociology, Medical Epidemiology and biometrics, Family Medicine I, Medical Ethics, Human Behavioral Development and Problems, and Psycho-Social-Spiritual Aspects of Life-Threatening Illness at DU campus)

   Clinical rotation performance   Feedback from residency

directors

Medical Knowledge

3.        Competently gather and present in oral and written form relevant patient information through the performance of a complete history and physical examination.

   Yr 2 OSCE   Physician and Patient (PAP)

course performance at TC campus, assessed by tutors using global rating forms and observed practical exams

   Course performance at DU campus in Applied Anatomy, Clinical Rounds & Clerkship (CR & C), Clinical Pathology Conference, and Integrated Clinical Medicine

   Clinical rotation performance

Patient Care;Interpersonal and Communication Skills

4.        Competently establish a doctor-patient relationship that facilitates patients’ abilities to effectively contribute to the decision making and management of their own health maintenance and disease treatment.

   Yr 2 OSCE and Primary Care Clerkship (PCC) OSCE

   PAP course performance at TC campus, assessed by tutors using global rating forms and observed practical exams

   Preceptorship and CR & C course performance at DU campus

   Clinical rotation performance

Patient Care; Interpersonal and Communication Skills

5.        Competently diagnose and manage common medical problems in patients.

   PCC OSCE   Clinical rotation performance

Medical Knowledge;Patient Care

6.        Assist in the diagnosis and management of uncommon medical

   Clinical rotation performance   Documented achievement of

Medical Knowledge; Patient Care;

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problems; and, through knowing the limits of her/his own knowledge, adequately determine the need for referral.

procedural skills in the Competencies Required for Graduation

Practice-Based Learning and Improvement

7.        Begin to individualize care through integration of knowledge from the basic sciences, clinical disciplines, evidence-based medicine, and population-based medicine with specific information about the patient and patient’s life situation.

   Clinical rotation performance   Feedback from residency

directors

Patient Care; Medical Knowledge; Interpersonal and Communication Skills; Professionalism

8.        Demonstrate competence practicing in ambulatory and hospital settings, effectively working with other health professionals in a team approach towardintegrative care.

   Yr 2 and PCC OSCE   PAP course performance at TC

campus, assessed by tutors using global rating forms and observed practical exams

   Physician and Society (PAS) course performance at TC campus

   Preceptorship, CR & C, and Introduction to Rural Primary Care Medicine course performance at DU campus

   Clinical rotation performance

Practice-Based Learning and Improvement; Systems-Based Practice

9.        Demonstrate basic understanding of health systems and how physicians can work effectively in health care organizations, including:      Use of electronic

communication and database management for patient care.

      Quality assessment and improvement.

      Cost-effectiveness of health interventions.

      Assessment of patient satisfaction.

      Identification and alleviation of medical errors.

   PAS course performance at TC campus

   Medical Sociology and CR & C course performance at DU campus

   Clinical rotation performance, especially the PCC

   Feedback from residency directors

   Feedback from local health plans

Practice-Based Learning and Improvement; Systems-Based Practice

10.     Competently evaluate and manage medical information.

   Critical reading exercises in PAS and other courses at TC campus

   Clinical Pathology Conference performance and exercises in Problem Based Learning Cases at DU campus

   Year 2 Health disparities project

   PCC EBM project

Patient Care; Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice

11.     Uphold and demonstrate in action/practice basic precepts of the medical profession: altruism, respect, compassion, honesty, integrity and confidentiality.

   PAS course performance at TC campus

   Preceptorship and Cr & C course performance at DU campus

   Clinical rotation performance   Participation in honor code

and student peer assessment

Professionalism

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program   Participation in anatomy

memorial   Participation in volunteer

service activities12.     Exhibit the beginning of a pattern

of continuous learning and self-care through self-directed learning and systematic reflection on their experiences.

   PBL cases at DU campus   Yr 2 Health disparities project   Clinical rotation performance   Participation in research

Professionalism

13.     Demonstrate a basic understanding of the healthcare needs of society and a commitment to contribute to society both in the medical field and in the broader contexts of society needs.

   Course performance in all years

   Introduction to Rural Primary Care Medicine course project at DU campus

   Involvement of students in international study

   Enrollment in RPAP, RCAM, and UCAM

   Yr 2 Health disparities project   Feedback from residency

directors   Participation in volunteer

service activities

Patient Care; Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice

These objectives are written to reflect the qualities and competencies expected of our graduates. Each objective specifies the expected competency level to be attained by our students, the outcome measures used to evaluate attainment of the objective, and the essential qualities and competencies of a physician (as defined by the six ACGME Essential Competencies) addressed by the objective. The Accreditation Council for Graduate Medical Education (ACGME) has formulated essential competencies felt to be necessary for physicians practicing in the current health care climate. They are:

     Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

     Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care

         Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

         Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals

         Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

         Systems-Based Practice, as manifested by actions that 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 optimal patient care

The objectives for the undergraduate curriculum can be grouped as follows:Objectives 1-3: Knowledge and skills addressed principally in the first two (preclinical)

curricular years;Objectives 4-9: Knowledge and skills addressed principally in the second two (clinical)

curricular years;Objectives 10-13: Knowledge, attitudes, and skills addressed throughout the curriculum.

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The objectives, which relate to the ACGME essential competencies, are designed to be modified for use also by the graduate (GME) programs at the University of Minnesota Medical School. Fellowship programs can modify the competency level stated in the objectives and the outcome measures to reflect their own programs, while maintaining the overall integration of basic learning objectives across undergraduate and graduate medical education.

One of the primary outcome measures for the objectives is clinical rotation performance. To expand on this; clinical rotation performance is assessed by attending physicians and residents using a Web-based global rating form, evaluating the following knowledge, competencies, skills, and attitudes:

     Medical knowledge and the ability to apply knowledge in clinical situations     Competency in patient care including communication and relationships with

patients/families     Skills in data gathering from the history, physical examination, clinical and

academic sources, and diagnostic tests      Assessment and prioritization of problems     Management of problems, including knowledge of patient data and progress     Appropriate decision making     Communication in written and oral reports     Professionalism, including: patient care and management in teams (work habits),

independent learning, personal characteristics, and commitment to medicine      Specific procedural skills (see report outlining Competencies Required for

Graduation)

Ratified by Education Council 2/18/03

SECTION VI. ADMINISTRATION (Please refer to Institution Policy Manual at

http://www.med.umn.edu/gme/residents/parta.html for Medical School Policies on the following: University of Minnesota Physicians, GME Administration Contact List, GME Administration by Job Duty; GME Organization Chart)

UMMC PROGRAM ADMINISTRATION

DIRECTOR & CHAIRMAN: CHARLES DIETZ, JR. M.D.Office:B234 Mayo Bldg

Phone:612.626.3345

Fax:612.626.3366

Pager:612.899.7591

Mail Code:MMC292

Email:dietz004@umn.edu

PROGRAM DIRECTOR, GREGORY B. SNYDER, M.D.Office:B228 Mayo Bldg

Phone:612.626.5587

Fax:612.626.5580

Pager:612.899.2586

Mail Code:MMC292

Email:snyde032@umn.edu

PROGRAM COORDINATOR, ZALIKA MUSKAT

Office:B228 Mayo Bldg

Phone:612.626.5388

Fax:612.625.5580

Pager:N/A

Mail Code:MMC292

Email:murr0300@umn.edu

ALRT GRADUATE MEDICAL EDUCATION MANAGER: SALLY SAWYER

Office:763 Mayo Bldg

Phone:612.625.3518

Fax:612.626.2696

Pager:N/A

Mail Code:MMC609

Email:sallyann@umn.edu

HCMC PROGRAM ADMINISTRATION

ASSOCIATE DIRECTOR: ANOTHONY SEVERT, M.D.Office: Phone: Fax: Pager: Mail Email:

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2E-20 HCMC 612.873.2036

612.904.4567

612.530.8654

Code:MMC822

sever025@umn.edu

PROGRAM COORDINATOR: PAMELA THOMPSON

Office:P4-221 HCMC

Phone:612.873.2036

Fax:612.904.4567

Pager:N/A

Mail Code:P4

Email:pamela.thompson@hcmed.org

PROGRAM COORDINATOR, HILTJE LOYD

Office:P4-221 HCMC

Phone:612.873.2718

Fax:612.904.4567

Pager:N/A

Mail Code:P4

Email:hiltje.loyd@hcmed.org

VAMC PROGRAM ADMINISTRATION

ASSOCIATE DIRECTOR: HOWARD ANSEL, M.D.Office:1Q-109

Phone:612.725.2038

Fax:612.727.5635

Pager:612.660.7016

Mail Code:114

Email:howard.ansel@med.va.gov

PROGRAM COORDINATOR: CAROL STEVENS

Office: Phone:612.467.2929

Fax:612.467.5635

Pager:N/A

Mail Code:114

Email:carol.stevens@hcmed.org

SITE CENTRAL CONTACT INFORMATION

UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW

420 DELAWARE STREET SE

MINNEAPOLIS, MN 55455PHONE 612.273.6004FAX: 612.626.3366

HENNEPIN COUNTY MEDICAL CENTER

701 PARK AVE SOUTH

MINNEAPOLIS, MN 55415PHONE 612.873.2036FAX: 612.94.4258

VETERANS AFFAIRS MEDICAL CENTER

ONE VETERANS DRIVE

MINNEAPOLIS, MN 55417PHONE 612.725.2038FAX: 612.727.5635

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Confirmation of Receipt Duty Hours Policy for Radiology

By signing this document you are confirming that you acknowledge that penalties will be applied to you for non-compliance of duty hours. This policy is on page 20 of your program manual.

This receipt will be kept in your personnel file.

Maintaining your duty hours is not only a GME requirement it is also a requirement for the completion of your degree.

Note: Failure to ensure accuracy of your rotation activities will be considered an act of Medicare fraud.

Duty hours are to be entered by 7AM on the first working day of the month. We are granting you the weekend now to get things in order.

All fixes indentified by Program Coordinator must be corrected by the following morning.

If the above do not occur:

Fellows on a U of M rotation will have their parking privileges revoked beginning the next day and will be in effect until the fellowship office has cleared you.

Fellows at HCMC or VAMC will have their vacation revoked or call will be applied at our discretion.

Fellows will have a letter placed in their permanent file reflecting a lack of professionalism if pattern continues.

Fellow Name (Please print)

Fellow Signature ________________________________________________________

Date __________________

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Confirmation of Receipt Duty Hours Policy for Radiology

By signing this document you are confirming that you acknowledge that penalties will be applied to you for non-compliance of duty hours. This policy is on page 20 of your program manual.

This receipt will be kept in your personnel file.

Maintaining your duty hours is not only a GME requirement it is also a requirement for the completion of your degree.

Note: Failure to ensure accuracy of your rotation activities will be considered an act of Medicare fraud.

Duty hours are to be entered by 7AM on the first working day of the month. We are granting you the weekend now to get things in order.

All fixes indentified by Program Coordinator must be corrected by the following morning.

If the above do not occur:

Fellows on a U of M rotation will have their parking privileges revoked beginning the next day and will be in effect until the fellowship office has cleared you.

Fellows at HCMC or VAMC will have their vacation revoked or call will be applied at our discretion.

Fellows will have a letter placed in their permanent file reflecting a lack of professionalism if pattern continues.

Fellow Name (Please print)

Fellow Signature ________________________________________________________

Date __________________

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