Clinical Experience

NICU/PICU/Plain films rotation

• Interpret plain film studies with an understanding of disease processes specific to the patient population

• Develop clear, concise imaging reports and communication with the neonatologists, critical care and various other pediatricians and pediatric subspecialists

• Help guide clinicians in the care of the patient, specifically in follow-up exams and the need for long-term imaging follow-up

• Understand and communicate radiation safety and help guide imaging exams in the safest manner possible

• Participate in weekly NICU rounds

• Provide teaching to radiology and pediatric residents
  
  

Nuclear medicine rotation

• Interpret and supervise nuclear medicine exams with an understanding of the disease processes specific to the patient population

• Understand and communicate the appropriateness of the exam

• Develop clear, concise reports and communication with the clinicians

• Guide follow-up to abnormal exams, including exams in other modalities

• Provide correlation of nuclear medicine exams with exams from other modalities

• Gain knowledge of nuclear agents for each exam and the specific properties as they pertain to imaging and safety

• Provide teaching to radiology and pediatric residents
  
  

Neuroradiology rotation

• Interpret CT and MR studies of the central and peripheral nervous system with an understanding of the disease processes specific to the patient population, including congenital and acquired conditions

• Understand the appropriateness of the exam and guide further imaging workup if necessary

• Develop clear, concise imaging reports and communication with the clinicians

• Understand radiation safety and how it affects the appropriateness of the exam

• Understand MR physics as it pertains to imaging findings

• Participate in radiology, neurology, brain tumor and rehabilitation conferences

• Provide teaching to radiology and clinical residents
  
  

Angio/Interventional radiology rotation

• Participate and interpret interventional procedures including, but not limited to: diagnostic angiography; interventional angiography; CT/US guided biopsies; drains and aspirations; vascular access of the head and neck, chest, abdomen, pelvis and extremities

• Understand radiation safety and techniques to minimize radiation exposure to the patient and operating radiologist

• Understand and communicate the appropriateness of the exam

• Help guide further imaging workup

• Participate in appropriate conferences

• Provide teaching to radiology and clinical residents
  
  

Body CT/MRI/US rotation

• Interpret CT/MRI/US studies of the chest, abdomen, pelvis and extremities (neonates to adolescents) with a knowledge of the disease processes specific to the patient population, including but not limited to: congenital and acquired heart disease; diseases of the lungs and chest wall; pediatric abdominal and pelvic tumors; bone tumors and benign lesions; pediatric joint disease; and trauma

• Understand MR physics as they pertain to imaging findings

• Develop clear, concise imaging reports and communication with the clinicians

• Participate in appropriate conferences

• Provide teaching to radiology and clinical residents
  
  

Evaluation policy and procedures for each rotation

The trainee will be evaluated every six months by the faculty involved in supervision. At the end of each rotation (once a month), the faculty member will complete an evaluation form. As a competency metric, the trainee will be given a computer-based diagnostic "pre-test" exam in the fall (September) covering all aspects of pediatric radiology. This same test will be administered eight months later (May) to evaluate the trainee's progress in competency and understanding. The results of this exam will be reviewed with the trainee both in September and May.

The trainee will meet with the program director four times a year (every three months) to discuss the trainee's performance in each rotation: fluoroscopy; neuroradiology; body imaging; chest & airway; interventional; and nuclear medicine. The discussion will also include the trainee's communication skills and professionalism. If weaknesses are determined, remediation suggestions will be made. Trainees will be given the opportunity for feedback at that time.

Below is the evaluation criteria for the core competencies for the pediatric radiology fellow:

Patient care

An evaluation of the fellow's patient care methods will be accomplished through the random distribution of written questionnaires to approximately ten patients/parents per week. These questionnaires will solicit feedback on the pediatric patient's clinical outcome based on how they perceive their experience of care received in pediatric radiology at UMKC. The questionnaire will be no longer than one page in length and will include questions regarding: length of time the patient had to wait for treatment; whether or not appropriate and compassionate care was received; if reasonable radiation safety precautions were discussed; if the reason for and the results of the test(s) were communicated; if the patient/parent felt comfortable with instructions for post-clinic care; and other areas of concern as they arise. The program director will review the questionnaire results with the fellow at the time of the semi-annual reviews for the purpose of exploring the most compassionate, appropriate, effective and efficient means of promoting health care and to insure that the fellow comprehends the importance of exemplary patient care.

Medical knowledge

Along with the pediatric fellow's specific responsibilities in each of her/his clinical rotations, the following ancillary learning experiences will be mandatory: participate in the Cleveland Clinic comprehensive core curriculum in pediatric radiology self-test modules; develop a teaching program for radiology residents; complete a review of the Department's of Pediatric Radiology CD teaching program; and be able to recognize and describe the top 100 pediatric diagnoses and top 100 pediatric neuroradiology diagnoses.

Interpersonal communication skills

The primary tool for establishing the effectiveness of the fellow's communication skills will be a 360-degree evaluation form, which will be distributed on a semi-annual basis to other residents (both radiology and pediatrics), nursing staff, technicians, transcriptionists, clinicians/referring physicians and patients/parents. The form will be used to evaluate the following basic skills and the results will be included in the fellow's performance review:

• Is the fellow's communication of information clearly understood by those who need the information?

• Is the fellow willing to take the time to answer questions and provide explanations?

• Is she/he willing to attempt to understand others' views?

• Does the fellow treat others with respect?

• Does her/his interactions with others tend to be agreeable or unpleasant?

• Does the fellow exhibit bias or is the care provided always equitable?

• How does the fellow deal with disagreements when they occur?

• Does she/he have adequate negotiation and conflict-management skills?

• Does the fellow accept responsibility for her/his actions?

• Does she/he complete tasks and fulfill duties in a responsible fashion (i.e., responding promptly when on call or when paged?)?

• Does she/he know the limits of her/his ability and ask for help when appropriate?

Practice-based learning

The fellow will be required to investigate and evaluate specific patient care practices. He/she will quarterly conduct a review of the literature and assimilate scientific evidence in conjunction with our current practices. This will include but not be limited to such items as:

• Workup of recurrent urinary tract infection

• Doppler flow evaluation for NEC

• Timing of the US and MRI in the neonate

• MR and CT angiography

• Transcranial Doppler

• When to order high-resolution chest CT, etc.

Professionalism

The tools for evaluating the fellow's professionalism include the 360-degree evaluation as noted above as well as: conference attendance records; the quarterly written faculty evaluations of the resident; and evaluations from the chairs of the departments of pediatrics and radiology (at both institutions), the director of pediatric surgery and the director of neonatology, as to the fellow's adherence to the principles of medical ethics.

Systems-based learning

Once per month, the fellow will present to the program director a discussion on a selected patient, beginning at the point the patient first meets the medical establishment. The effectiveness of the fellow in these workup presentations will be considered as part of the written performance evaluations. The workup will include but not be limited to: the consultation with the referring physician; the discussion of the appropriateness of the diagnostic procedures and the different procedural pathways available; communication of the diagnosis of the radiological exam to the referring physician; the course of treatment followed; the timeliness of treatment; and the perception of the referring physician and the patient/parent regarding the outcome of the treatment process.