PGY2 Emergency Radiology
Supervisor: Dr. Paul Jeon, Health Sciences Centre
The following is an outline of the goals and objectives of the Emergency rotation during PGY2, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. A pass mark is 70%. The inability to pass the exam couldrender the rotation incomplete, and the rotation will be completed at a later date.
Duties and Responsibilities:
At the beginning of the rotation, the ER resident will inform the ER department of his/her responsibility to help organize, coordinate, recommend and whenever possible report appropriate diagnostic imaging tests.
It is the duty of the resident to function at all times in a professional, mature and responsible manner, whether dealing with patients, colleagues, or health care workers.
The ER resident must review cross sectional exams with staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or ER physician) dictate the same.
A verbal report must be provided to the responsible ER physician for major findings that are detected; the details of this communication must be then acknowledged subsequently at the end of the generated report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).
The ER resident will present cases to staff in a prepared, organized fashion.
The ER resident will be responsible to prepare 2 ER cases, on Powerpoint (in an ICR format) from a provided list, to the ER supervisor by the end of the rotation.
The resident is responsible to review and read vigorously from the suggested reading list.
An end of rotation exam will be given during the last week of the rotation to assess knowledge and where applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.
Specific Daily Duties
Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.
The ER Resident will review at least 20 ER PF day with the staff designated in the ER Plain Film category contained in the Work Rota. When there is no staff designated in this slot, then the review can occur with the staff designated in the standard Plain Film slot.
The ER resident will review the ER renal colic CT exams ordered the evening before, but performed the morning after, with the designated CT body staff for that day.
Whenever possible, the ER resident is responsible to report any cross sectional studies that have been performed on patients from the ER, with the designated staff for that day (i.e. ER renal US with the radiologist covering US that day).
Required Reading List
Please note: The books needed will be provided from Dr. Jeon at the beginning of the rotation and must be returned on the final day of the rotation.
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Suggested Reading List
Please Read: The corresponding RSNA physics module, as outlined in the physics curriculum
Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, Fourth Edition, 2000
Harris JH, Mirvis SE. The Radiology of Acute Cervical Spine Trauma. Williams and Wilkins, Baltimore, MD, Third Edition, 1995.
McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.
Mirvis SE, Young JWR. Imaging in Trauma and Acute Care. Williams and Wilkins, Baltimore, MD, 1992.
Novelline RA. Advances in Emergency Radiology, Volumes I and II, Radiological Clinics of North America. WB Saunders, Philadelphia, PA, 1999.
Stern EJ. Trauma Radiology Companion. Lippincott-Raven, Philadelphia, PA 1997.
West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency and Trauma Radiology. American Roentgen Ray Society, 2000
- Medical Expert
- Face and Neck-5
After completing this rotation, the resident should be able to:
- Identify and describe the basic PF/CT/US anatomy (where applicable) of the CNS, Respiratory, Cardiovascular, Abdominal/Pelvic (including GI, GU and OB/Gyne), and MSK systems.
- Discuss the ER radiology Curriculum after studying the accompanying ER Core Curriculum and content structure/suggested readings: ( see appendix 1)
A Central Nervous System - 3
- Chest - 8
- Gynecological and Obstetrical - 14
- Male Genitourinary-16
- Upper Extremity -17
- Pelvis and Hip-19
- Lower extremity-21
- Subdural hematoma
- Develop and master a systematic approach to the interpretation of plain radiographs of the spine, chest and abdomen.
- Discuss in detail the various CT/US imaging protocols used in the ER rotation.
- Distinguish abnormal from normal findings on PF( where applicable)/ CT images of the brain, head/neck and spine regions and to recognize the major disease processes that occur in these areas particularly in the following areas :
- Extra-axial hemorrhage
- Epidural hematoma
- Cortical Contusion/traumatic hemorrhage
- Parenchymal Injuries
- Diffuse Axonal Injury
- Brainstem Injury
- Non-traumatic Hemorrhage
- Subarachnoid Hemorrhage
- Parenchymal Hemorrhage
- Herniation Syndromes
- Cerebral Infarction
- CNS Infections
- Spinal trauma
- Facial Fractures
- Acute Infections of the Sinuses and Neck
- Distinguish abnormal from normal findings on PF/US/CT ( where applicable) images of the chest, and to recognize the major disease processes that occur in these areas particularly in the following areas :
- Pulmonary Embolism
- Pulmonary Edema
- Thrombo-embolic Disease
- Deep Vein Thrombosis
- Solid/Hollow Visceral Injuries
- Pericardial Effusion/Tamponade
- Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the abdomen and pelvis and to recognize the major disease processes that occur in these areas particularly in the following areas:
- Abdominal Trauma:
- Hemoperitoneum/Intraperitoneal Fluid
- Intraperitoneal /Retroperitoneal Hemorrhage
- Gas Collections –intraluminal and extraluminal
- Bowel and Mesenteric Injuries
- Abdominal Wall and Diaphragmatic Injuries
- The Peritoneal Cavity
- Non-Traumatic Abdominal Emergencies
- Liver and Biliary Tract
o Obstructive and Non-obstructive
- GI Tract
- Bowel Obstruction
- Bowel Infarction
- Bowel Infection
o Infectious Enteritis/Colitis
- Inflammatory Bowel Disease
- Epiploic Appendagitis/Omental Infarction
o Ulcerative Colitis
- Urinary Tract Calculi
o Renal Abscess
- Distinguish abnormal from normal findings on Gynecologic Imaging of the pelvis and to recognize the major disease processes that occur in these areas particularly in the following areas:
- Ovarian Torsion
- Ovarian Cystic Disease
- Pelvic Inflammatory Disease
- Subchorionic Hemorrhage
- Spontaneous Abortion/Fetal Demise
- Ectopic Pregnancy
- Distinguish abnormal from normal findings in imaging the male GU system and to recognize the male GU emergencies that occur in these areas particularly in the following areas:
- Acute Non-traumatic Scrotal Conditions
- Testicular Torsion
- Acute Scrotal Fluid Collections
- Testicular Abscess
- Fournier’s Gangrene
- Distinguish abnormal from normal findings on PF/US/ CT ( where applicable) images of the MSK system and to recognize the major disease processes that occur in these areas particularly in the following areas:
- Upper Extremity
- Scapular/Clavicular fractures
- Shoulder/Elbow Dislocations
- Forearm fractures /dislocations
- Metacarpal/Carpal fractures/dislocations
- Pelvis and Hip
- Pelvic Ring Fractures
- Isolated Pelvic Fractures
- Acetabular Fractures
- Hip fractures/disloctions
- Femoral Fractures
- Septic Arthritis
- Tibial Fractures
- Lower Extremity
- Ankle Injuries
- Patellar Injuries
- Knee Dislocations
- Talar/Subtalar Fracture/Dislocation
- Tarso-metatarsal dislocation ( Lis Franc)
- Metatarsal Fracture/Dislocation
- Septic Arthritis
- Develop a systematic approach in the CT evaluation of a patient involved in multi trauma.
- Gain knowledge of anatomy and pathology related to organ systems commonly involved in trauma including the brain, spine, chest, abdomen and pelvis, cardiovascular and musculoskeletal system. ( See objectives for specific topics)
- Have film reading ability of plain film examinations from the Emergency Room as well as Ultrasound and CT examinations ordered through the Emergency Room.
- Be able to recommend an appropriate imaging study in an emergency situation.
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
- Health Advocate
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.