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					             Vascular Interventional Radiology Curriculum, Goals & Objectives

Goals & Objectives for All Vascular Interventional Radiology Rotations

1.    Determine the appropriateness of patient selection for a requested procedure through
      review of available history, imaging, laboratory values and proposed/expected outcomes
      of the procedure, as well as obtain deficient information in these areas.
2.    Demonstrate understanding of history/physical findings or treatment scenarios that would
      require pre-procedure assistance from other specialty disciplines such as cardiology,
      anesthesia, surgery and internal medicine.
3.    Obtain informed consent after a review with the patient of the procedure(s), risks,
      benefits and alternative therapeutic options/procedures.
4.    Recognize monitoring abnormalities and physical signs/symptoms that need immediate
      attention during a procedure.
5.    Demonstrate appropriate post procedure recovery, patient management and follow-up.
6.    Demonstrate understanding and appropriate management of certain pharmacological
      considerations:

                 a. Drug/Contrast Reactions
                 b. Antibiotic Therapy
                 c. Conscious Sedation
                 d. Anesthesia/Analgesia
                 e. Anticoagulation


7.    Interpret non-invasive imaging studies to determine that the requested procedure is
      appropriate, and if not, assign the correct procedure.
8.    Identify factors from patient history, physical and laboratory values that indicate potential
      risks for conscious sedation and assign an ASA score.
9.    Identify factors from patient history, physical and laboratory values that indicate potential
      risks for bleeding, renal damage, cardiovascular problems, breathing abnormalities or
      adverse drug interactions during or after the procedure.
10.   Properly evaluate a patient before an interventional procedure using a focused history and
      physical format.
11.   Accurately dictate all studies in a timely manner.
12.   Demonstrate proper communication with the referring physician and/or other consulting
      physicians regarding procedure appropriateness and/or potential risks that need further
      evaluation.
13.   Recognize monitoring abnormalities and physical signs/symptoms that need immediate
      attention during a procedure.
14.   Identify increased risks of blood sugar abnormalities, changes in blood pressure, and
      infection either before, during or after a procedure and assign the proper medication
      regimens including, but not limited to, periprocedure food/insulin intake, adjustment of
      blood pressure medications, adjustment of anticoagulation medications or initiation of
      prophylactic/therapeutic antibiotic coverage.
15.   Administer and maintain effective conscious sedation for patient comfort during and after
      the procedure.
16.   Recognize and treat complications during and after the procedure including but not limited
      to contrast/anaphylactic reaction, over sedation, pain, nausea/vomiting, arrhythmia,
      decreased oxygen saturation, sepsis, hypertensive urgency/emergency, low blood pressure,
      hyper-hypoglycemia or bleeding/hematoma.
17.   Provide appropriate patient follow-up in the inpatient and outpatient settings.
18.   Identify the types of radiation created and their sources during fluoroscopy.
19.   Identify the organs especially sensitive to the effects of ionizing radiation.
20.   List the most common methods of radiation protection, their principles and practical
      applications.
21.   Understand the rationale for lead protective clothing, lead glasses, shields and gloves.
22.   Understand methods to decrease radiation dose to the patient and operator during IR
      procedures.
23.   Identify procedures at high risk for radiation skin injuries and how to avoid them.
24.   Identify patients at high risk for blood borne pathogens.
25.   Know the incidence of hepatitis-C in the IR patient population.
26.   Describe methods to reduce accidental exposure to blood and body fluids in the IR suite.
27.   Recognize and promote a team environment in the practice of interventional radiology
      including radiologic technologists, radiology nurses, nurse practitioners, patient care
      coordinators and physicians' assistants.
28.   Support and participate in the continuing medical education for members of the IR team.
29.   Treat all members of the IR team with respect.
30.   Understand the importance of developing referral relationships with primary care
      physicians.
31.   Communicate effectively with referring physicians.


The above rotational goals incorporate the core competencies as follows:

Medical Knowledge: Goals 1-31
Interpersonal and Communication Skills: Goals 3, 10-12, 27-31
Practice Based Learning and Improvement: Goals 1-3, 10-12, 17, 27-31
Professionalism: Goals 3, 12, 27-31
Patient Care: Goals 1-20, 22-25
Systems Based Practice will be taught through the QA conferences, conferences prepared by our
departmental administrator and through the core competency series presented by our GME
office.


Goals and Objectives for SPECIFIC Vascular Interventional Radiology Rotations

VIR Radiology – Rotation 1

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

   1.    Take appropriate history and physical for vascular access cases.
   2.    Take appropriate history and physical for dialysis access management.
   3.    Obtain informed consent for vascular access.
   4.    Obtain informed consent for PVD cases.
   5.    Obtain informed consent for dialysis access intervention.
   6.    Obtain informed consent for filter placement.
   7.    Demonstrate basic knowledge of angiographic interpretation.
   8.    Identify normal vascular anatomy of the abdominal aorta and its branches.
   9.    Identify normal variants of the thoracic aorta and its branches.

Technical Skills: At the end of the rotation, the resident should be able to:

   10. Demonsttrate competency in basic venous access.
   11. Demonstrate competency in routine femoral arterial access and aortography.
   12. Demonstrate competency in routine venography.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be
able to:

   13.   Perform standard admission.
   14.   Understand indications for various venous access devices.
   15.   Understand basic triage duties.
   16.   Review patient history and determine appropriateness of requested procedures.


VIR Radiology – Rotation 2

Knowledge Bases Objectives: At the end of the rotation, the resident should be able to:

   1.    Take appropriate history and physical for PVD.
   2.    Take appropriate history and physical for biliary and urologic drainage procedures.
   3.    Obtain informed consent for biliary and urologic drainage procedure.
   4.    Identify vascular pathology and understand its angiographic interpretation.
   5.    Understand urologic anatomy and pathology.
   6.    Understand management of drainage catheters including biliary and nephrostomy
         catheters.
   7.    Understand indications, outcomes and potential complications of basic IR
         procedures.

Technical Skills: At the end of the rotation, the resident should be able to:

   8.    Demonstrate competency in selective arteriography and venography.
   9.    Demonstrate competency in percutaneous nephrostomy.
   10.   Demonstrate competency in tunneled line and port placement.
   11.   Perform daily triage duties efficiently.
   12.   Run efficient evening rounds.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be
able to:

   13. Perform pre and post-procedural management of IR patients.
   14. Make decisions about when to alert referring physicians to radiographic findings.


VIR Radiology – Rotation 3

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

   1.    Take appropriate history and physical for TIPS.
   2.    Take appropriate history and physical for oncologic interventions and embolotherapy.
   3.    Obtain informed consent for TIPS.
   4.    Obtain informed consent for oncologic interventions and embolotherapy.
   5.    Understand indications and clinical management of TIPS patients.
   6.    Understand biliary anatomy and pathology.
   7.    Understand gastrointestinal hemorrhage evaluation and management planning.
   8.    Understand indications for temporary and permanent lVC filter placement.

Technical Skills: At the end of the rotation, the resident should be able to:

   9. Perform basic venous angioplasty and stenting.
   10. Demonstrate competency in routine percutaneous cholangiography.
   11. Competency in lVC filter placement.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be
able to:

   12. Communicate with referring physicians about recommendations for pre and post-
       procedural care.
VIR Radiology – Rotation 4

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

   1.    Understand indications for endovascular procedures for treatment ofPVD, including
         renovascular disease and mesenteric vascular disease.
   2.    Understand indications for interventional oncologic procedures.
   3.    Understand indications and management of patients for uterine artery
         embolization.
   4.    Understand indications, outcomes and potential complications of complex lR
         procedures.

Technical Skills: At the end of the rotation, the resident should be able to:

   5.    Demonstrate competency in iliac and SFA angiop1asty and stenting.
   6.    Demonstrate competency in routine percutaneous cholangiography.
   7.    Demonstrate competency in TIPS.
   8.    Demonstrate competency in routine embolotherapy.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be
able to:

   9. Make recommendations about the indications for IR procedures.
   10. Make decisions regarding patient management and follow up.


Recommended Texts:

Recommended texts by section are listed on the resident website at www.radres.vcu.edu and are
listed under the tab “recommended text”.

Resident Evaluation:

Residents will be evaluated utilizing the global Resident Evaluation form, performance on the In-
training Examination, and end of rotation examinations, which are oral boards type cases tailored
for Rotations 1-4.

				
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