Albany IR

Medical Student VIR Elective Course Description & Goals and Objectives

Introduction

Welcome to Interventional Radiology.  IR is a subspecialty of radiology that relies on imaging and minimally invasive strategies to diagnose and treat a wide spectrum of disease.  We believe that IR is one of the most enjoyable and exciting professions in medicine.  The variety of cases performed by our specialty is broad and stimulating.  The technology we employ on a daily basis is constantly being refined and improved upon, making it possible for new procedures to be developed on a regular basis.

Our goal is to provide you with a comprehensive educational experience in IR, including the performance of procedures and the integration of these procedures into clinical management of patients.  During your IR elective rotation, it is our hope that you will gain a progressively increasing understanding of many disease entities commonly diagnosed and treated by IR, including their clinical presentations and current modes of treatment.

People to Know on IR

  • Attending Physicians: Meridith Englander; Allen Herr, MD; Lawrence Keating, MD; Kenneth Mandato, MD; Gary Siskin, MD; Christopher Stark, MD
  • Nurse Practitioners: Laura Bailey, FNP; Chris Doti, FNP; Nancy Spencer, FNP
  • IR Technologist Manager: Heather Fairchild
  • Head Nurse: Vanessa Rivera
  • IR Schedulers: Lisa, Sandy 
  • Academic Coordinator: Rachelle Stepnowski

Goals and Objectives

The goal of the medical student elective is to have our students provide patient care through safe, efficient, appropriately utilized, quality-controlled diagnostic and/or interventional radiology techniques. The importance of clinical practice will be emphasized. At the conclusion of the elective, the student will be able to:

  • Understand the essential components of direct patient management during an entire episode of care surrounding performance of an image-guided procedure, including pre-procedure assessment and post- procedure management in both the inpatient and outpatient setting.
  • Understand the criteria used to select patients for image-guided procedures based on history, physical examination, imaging studies, laboratory analysis, and proposed/expected procedural outcomes.
  • Understand the interaction that interventional radiologists must have with other specialties to provide comprehensive patient care.
  • Understand the interaction that interventional radiologists must have with the members of the IR team (nurses, technologists, mid-level providers, secretaries) to successfully care for patients.
  • Understand the workflow in the interventional radiology suites.
  • Understand the clinical presentation, diagnosis, treatment, and long-term management of the vascular and nonvascular disease processes commonly encountered and treated by interventional radiologists.
  • Demonstrate proficiency in the performance of Seldinger technique and the following interventional procedures: paracentesis, thoracentesis, and venous access.
  • Understand the importance of ongoing quality improvement initiatives within interventional radiology with the goals of improving patient safety, reducing errors, and improving patient outcomes.

                       

Competency-Based Objectives

Patient Care:

Medical students must demonstrate an ability to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. By the end of the elective, medical students will be expected to:

  • Evaluate a patient prior to an image-guided procedure in the inpatient or outpatient setting with preparation of a thorough consultation that includes a history, physical examination, review of medications, lab studies, and imaging studies, and the formation of an assessment and plan.
  • Observe and become familiar with the process informed consent from a patient through discussion of the potential risks and benefits of a proposed procedure and alternative therapeutic options. 
  • Competently perform Seldinger technique and basic interventional procedures such as paracentesis, thoracentesis, and venous access.
  • Develop basic guidewire and catheter skills.
  • Demonstrate the appropriate utilization of sterile technique during invasive procedures.
  • Identify factors from a patient’s history, physical examination, and laboratory values that allows for the assignment of an ASA score to indicate potential risk for conscious sedation.
  • Identify factors from a patient’s history, physical examination, and laboratory values that indicate potential risks for bleeding, cardiovascular problems, respiratory abnormalities, renal injury, and adverse drug interactions during or after an interventional procedure.
  • Recognize physical signs/symptoms that require immediate attention during a procedure.
  • Demonstrate a general understanding of how to manage certain pharmacological considerations surrounding the performance of image-guided procedures (e.g., drug/contrast reactions, antibiotic therapy, moderate sedation, analgesia, anticoagulation, blood pressure, diabetes management).
  • Provide appropriate patient follow-up in the inpatient and outpatient setting with effective communication to referring physicians.
  • Recognize complications that may potentially arise during and after image-guided procedures (e.g., contrast/anaphylactic reaction, over-sedation, pain, nausea/vomiting, decreased oxygen saturation, hypertensive urgency/emergency, low blood pressure, hyper-hypoglycemia or bleeding/hematoma).
  • Demonstrate an understanding of radiation exposure during image-guided procedures. Medical students must be familiar with radiation safety principles when performing interventional procedures and are expected to:
  • Understand the basic components of a fluoroscopy unit.       
  • Understand how radiation exposure is monitored.     
  • Understand the principles and practical applications of radiation protection.
  • Understand the rationale for lead protective clothing, lead glasses, shields and gloves.
  • Understand methods to decrease radiation dose to the patient and operator during interventional radiology procedures.
  • Demonstrate an understanding of the risk of occupational injury during the performance of image-guided procedures. Specifically, medical students should be able to:
  • Know the incidence of Hepatitis-C and HIV in the interventional radiology patient population
  • Describe methods to reduce accidental exposure to blood and body fluids in the interventional radiology suite.

Medical Knowledge:

Medical students must demonstrate knowledge about established and evolving biomedical, clinical, epidemiological and social-behavioral sciences and the application of this knowledge to patient care. By the end of the elective, medical students will be expected to:

  • Engage in continuous learning about fundamental interventional radiology techniques.
  • Demonstrate that they read interventional radiology-related textbooks and journals in the context of their training.
  • Demonstrate knowledge of the common indications for the following interventional radiology procedures:
  • Central venous access
  • Percutaneous nephrostomy
  • Percutaneous cholecystostomy and biliary drain placement
  • Abscess drain placement
  • Gastrostomy tube placement
  • Pulmonary arterial and deep venous thrombolysis
  • TIPS placement
  • IVC filter placement
  • Attend weekly didactic lectures in interventional radiology and participate in topic-based discussions at the weekly interventional radiology fellow’s conference.
  • Attend multidisciplinary conferences (such as GI tumor board).
  • Prepare a case presentation to present to the interventional radiology staff at the completion of the elective.
  • Participate in simulation training at the Albany Medical College Patient Safety and Clinical Competency Center

Practice-Based Learning and Improvement:

Medical students must be able to investigate, evaluate, and improve patient care practices. By the end of the elective, medical students will be expected to:

  • Attend and actively participate in Interventional Radiology Morbidity and Mortality Conference and the Interventional Radiology Quality Improvement Meeting with the goal of systemically analyzing the quality of IR practice.
  • Facilitate the learning of other students and health care professionals.
  • Use information technology to manage patient care, access on-line medical information, and support one’s own education and the education of other medical students.

Interpersonal and Communication Skills:

Medical students must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates. By the end of the elective, medical students will be expected to:

  • Work effectively with others as a member or leader of a health care team or other professional group.
  • Effectively work alongside the IR fellow or residents to coordinate daytime inpatient procedures.
  • Effectively communicate with referring physicians and consultants regarding procedure appropriateness and potential risks that require further evaluation prior to performance of an image-guided procedure.
  • Effectively communicate with patients and their families in a caring manner regarding the medical conditions being treated, the image-guided procedures being performed, and how these procedures fit into an overall treatment plan.
  • Clearly describe conscious sedation and the following procedures to a patient:
  • Arterial access
  • Venous access, including:
  • Tunneled and non-tunneled hemodialysis catheter placement
  • Port placement
  • PICC placement
  • Hohn and tunneled Hickman catheter placement
  • Percutaneous fluid/abscess drainage
  • Nephrostomy, cholecystostomy, and gastrostomy tube placement
  • Percutaneous biopsy

Professionalism:

Medical students must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. By the end of the elective, medical students will be expected to:

  • Demonstrate a commitment to high standards of professional conduct, including altruism, compassion, honesty, and integrity.
  • Follow principles of ethics and confidentiality and consider religious, ethnic, gender, educational, and other differences in interacting with patients and other members of the health care team.
  • Demonstrate a commitment to excellence and on-going professional development.
  • Comply with institutional and departmental requirements (dress code, wearing and submitting radiation badges, displaying ID, etc.)
  • Serve as a role model for other medical students.
  • Demonstrate a willingness to perform additional duties that contribute to the overall patient care and academic interests of the section.

Systems-Based Practice:

Medical students must 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 care that is of optimal value.

  • Understand how the components of the local and national healthcare system function independently and how changes to improve the system involve group and individual efforts.
  • Understand the importance of practicing cost-effective health care and resource allocation that does not compromise quality of care.
  • Consult with other healthcare professionals and educate healthcare consumers regarding the most appropriate utilization of imaging resources.
  • Demonstrate a willingness to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.

 

Elective Structure

Each student will be assigned to a 2 or 4-week elective with the interventional radiology section. Elective applications are completed in the spring of the MS3 year through Web Advisor and will be approved on an individual basis by a physician member of the IR service. Only 4-week electives will be offered for the first four blocks of the academic year. A maximum of two students will be assigned to each elective block. Scheduling preference will be afforded to those students planning a career in IR. Two and 4-week electives will be available for the remainder of the academic year.

General Expectations

It is important to know that medical students are expected to participate in all aspects of the IR service.  As with most things in life, what you get out of this experience will in large part depend on what you put into it.  We expect that you will actively participate in the evaluation of patients prior to procedures, the procedures, and the evaluation of patients after procedures.

Alongside our residents, fellows, and attendings, you are expected to consult with referring physicians, discuss procedures with patients, scrub into procedures, see patients on the floor, etc.  We realize that the IR rotations can be intellectually and physically challenging for many medical students.  Please do not hesitate to ask questions and to ask for help when you need it.  Our physicians, nurse practitioners, nurses, and technologists are dedicated to providing medical students with a good learning experience.

We understand that not every medical student rotating on this service does so with the intention of specializing in IR.  Therefore, an important goal of this rotation is to provide you with an understanding of the role of IR in the diagnosis and management of patients with a variety of medical conditions.  The diagnostic side of IR requires an understanding of the clinical and imaging findings inherent to these conditions.  The management side of IR requires an understanding of the steps required to evaluate patients prior to common IR procedures and the knowledge regarding the indications and contraindications, technique, and potential outcomes of these procedures.

IR is an area of the hospital that requires teamwork for success.  This does not just refer to teamwork amongst physicians.  Every member of the IR team is critical and is what enables us to provide care to our patients.  Success on this rotation will require you to understand the dynamics of IR team and to understand the role that each member plays during the course of the day.  It is our expectation that all members of the IR team, including our nurse practitioners, nurses, technologists, and secretaries, are treated with respect.  Members of our staff attend morning rounds so they can learn about the patients being treated on that day and anticipate the roles they will play during the day’s procedures.  Therefore, effective two-way communication is critical in this setting.  There is something to be learned from every member of this team and the skills they bring to the care we provide our patients. 

Finally, we all take a great deal of pride in the service we provide to the patients and physicians in our hospital.  When you rotate on this service, you are part of this team and therefore, we expect that you will act professionally and present yourself appropriately to our patients and our referring physicians at all times. 

Daily Routine

Morning rounds begin promptly at 7:30 am and are held in the control area of the IR procedure suites.  You should plan on arriving in the IR department at 6:30AM in order to prepare for morning rounds and can assist residents, fellows and nurse practitioners in making sure that the first patients are ready for their procedures to start immediately after rounds.  In addition, arrive with enough time evaluate an inpatient or two prior to rounds with an IR fellow.  Arriving within 5 minutes of rounds will demonstrate to the staff that you are not fully participating in the IR service and not embracing a responsible work ethic.  You must contact a member of the IR service (IR attending, IR fellow, IR board technologist, IR secretary) if you are going to be late or absent for any reason.  In addition, do not assume that anybody on IR knows when you might have an obligation outside of IR that will take you away from the IR service.  You must let Rachelle or someone in IR know if you are not going to be present on any day during your rotation.

During rounds, all of the scheduled patients are reviewed with the attendings, nurse practitioners, nurses, and technologists who are scheduled to be working on that day.  Medical students are expected to present any patient they evaluated with a resident or fellow during rounds.  Presentations are meant to be brief and should include a pertinent history stressing why that particular procedure is appropriate for that particular patient, relevant labs, and issues that may interfere with performance of the procedure (e.g., lab abnormalities, conflicts with other tests or procedures, NPO status, anesthesia requirements, etc.).  When available, any previous pertinent imaging studies should be reviewed prior to rounds and available for presentation.

Following board rounds, an IR attending, one of the IR fellows, the IR resident, and medical students will complete walking rounds. During walking rounds, the IR team will see patients who previously underwent an IR procedure, such as an angiogram and/or embolization, drainage catheter placement, venous catheter placement, as well as new consults that are more complex than average (i.e. TIPS placement, chemo/radioembolization, pain management, etc.). Medical students are expected to actively participate in walking rounds and should work with the IR fellow(s) to become familiar with the patients ahead of time. While on walking rounds, the first scheduled outpatients are brought into rooms so that their procedures can be performed.  In addition, inpatients requiring procedures are added to the schedule; a member of our staff must see these patients before they can be brought to the department for their procedure.  You may be made aware of inpatient add-on cases by an IR fellow, the IR board technologist, or one of the IR secretaries. 

Procedures are then performed on a rolling basis throughout the day, and typically performed in one of five angiography suites, the IR CT scanner, the ultrasound department, or in the radiology observation area.  All procedures are supervised by either an attending or nurse practitioner.  Outpatients are usually scheduled at 8:00, 9:30, 11:00, and 1:00 with inpatient procedures being performed at other times during the day (unless their procedures need to be done emergently).  While each room may break for lunch at some point in the middle of the day, there is no defined lunch period for the department in its entirety, which means that procedures are performed on an ongoing basis throughout the day. 

You will notice immediately that the day’s schedule is maintained electronically on monitors located throughout the department.  This Electronic White Board enables us to organize the day’s work into the different procedure rooms and to keep track of the status of each patient as the day progresses.  The schedule is color-coded, with each color representing a step in patient status (a legend is located next to the monitor in the control area of the angio suites).  A designated technologist, the nursing staff, and the IR secretaries maintain the color-coding during the course of the day.  There are a few colors which are important for you to recognize:

Dark Blue: The patient has arrived in the department.  This signals the need for the patient to be evaluated prior to their procedure.

Light Blue: The patient is being worked up.  In order for the patient status to be light blue, someone must tell the board technologist that they are working up a patient.

Green: The patient has been evaluated and is ready to come into the procedure room.

Orange: Transportation has been contacted to bring this inpatient to IR for their procedure.

Purple: The patient is in the angio suite and either undergoing or getting ready to undergo their procedure.

Red: The patient is not ready for one reason or another.  The board technologist will usually know why the patient is on hold.

There is no defined ending to the IR day or to the day of the medical student rotating on the IR service.  This is not a shift-style rotation.  We therefore cannot tell you that you will finish your day at a particular time.  Once the day’s procedures are completed, you should be working in conjunction with an IR fellow to prepare the patients for the next day.  This means reviewing the charts for all scheduled outpatients to gain an understanding of why they are coming to the hospital and what procedure they will be undergoing.  It also means seeing all scheduled inpatients to evaluate requests for appropriateness, to determine if any additional testing (e.g., imaging, labs, etc.) needs to be done prior to their procedure, to obtain informed consent patients for their procedure, and to make sure appropriate orders are on the chart (e.g., stopping anticoagulation, NPO, etc.).

 

Clinical Expectations

Pre-Procedure Responsibilities

1)    Pre-Procedure Consultation

It will be important for you to review the chart and meet the patient prior to the procedure. Prior to undergoing a procedure in IR, every patient must have a pre-procedure note in his or her chart. The note is to be completed by the resident, fellow, attending, or nurse practitioner.  The medical student should assist the fellow or resident in gathering appropriate information for the procedure note, however the note itself needs to be completed by an MD or NP. This pertains to all inpatients and outpatients.  For outpatients, this is done in the radiology observation area.  For inpatients, this is done in their room either the night before their scheduled procedure or on the day of the procedure (for add-on cases).  The note is not meant to be a comprehensive history and physical but rather one directed to the procedure being requested or the clinical question being asked. The note must include the following information:

  • Pertinent History
  • Physical Examination: The items covered should be relevant to the planned procedure (e.g., pulses for an angiogram to include femoral, popliteal, DP and PT; thrill/bruit for a dialysis fistulagram, etc.)
  • Allergies (e.g., medications, latex, etc.)
  • Current Medications
  • Pertinent Labs: In general, it is preferable to have a CBC with platelets, coagulation studies (PT, PTT, INR), and a BUN and creatinine prior to most procedures.  Any abnormal lab results should be communicated to the IR staff so the appropriate intervention can be determined prior to the procedure (e.g., platelet transfusion, FFP, etc.).  In general, a creatinine >1.5, a platelet count <75K, and an INR >1.5 should be brought to our attention.
  • Results of Pertinent Imaging Studies: This includes the results of diagnostic testing that led to the request for an IR consultation (e.g., ultrasound demonstrating biliary dilatation, CT scan demonstrating an abdominal abscess, etc.) and the results of any previous IR procedures.
  • DNR Status (if applicable)
  • ASA Score: Every patient needs an ASA score assigned to them before undergoing conscious sedation.
  • Mallampati Classification: This is also necessary prior to undergoing conscious sedation.

If an imaging study or lab work is required prior to a procedure, it should be the IR physician or nurse practitioner who places the order and follows-up on the results.  It is not appropriate for any member of the IR staff to expect that another team should do our work prior to one of our procedures. Importantly, the consult must be neat and complete.  If our consults are sloppy and incomplete, then the work that we do for our patients will be perceived as sloppy and incomplete.

2)    Informed Consent

A witnessed, informed consent must be obtained from every patient prior to an IR procedure.  This consent must be obtained by a member of the IR team (MD or NP) and not by the referring physician.  Although consent for procedures cannot be obtained by the medical student, he or she can serve as the witness to the consent. The consent must be for the planned procedure, for any possible additional procedure, and for conscious sedation.  It must be obtained from the patient or from the patient’s designated health care proxy.  The discussion during the informed consent process must be done in a compassionate manner that allows the patient to be confident in the care that they are going to receive.  The discussion must include the following points:

  • Reasons for undergoing the procedure
  • Technique utilized during the procedure
  • Risks and benefits of the procedure.  This means that you must be knowledge about the potential complications of our procedures before obtaining informed consent from a patient.
  • Consequences of refusing the procedure
  • Alternative therapies

3)    Pre-Procedure Orders

After a consultation has been prepared and consent has been obtained, it is usually necessary to add some orders to the chart of an inpatient prior to their planned procedure.  This includes an NPO order (patients need to be NPO for 6-8 hours prior to an IR procedure in order to receive conscious sedation), premedication for patients allergic to contrast, IV access, hydration, and others.  Necessary orders should be discussed with one of the IR fellows, nurse practitioners, or attendings if you are uncertain about what needs to be done.

4)    Site-Marking

Site marking is an important part of the universal protocol performed prior to all invasive procedure to insure that the appropriate procedure is being performed on the appropriate patient.  In general, image-guided procedures are exempt from site marking.  However, there are important exceptions and these are in areas where laterality may be an issue.  For example, we want to make sure that a patient requiring a right-sided nephrostomy tube does not have a tube placed on the left side.  Therefore, prior to any procedure where laterality is a potential issue, the site of the procedure must be marked by a physician or nurse practitioner (i.e., dialysis fistulagram, nephrostomy tube, thoracentesis, etc.). 

Intraprocedural Responsibilities

We recognize that a big part of IR is the performance of procedures and in turn, this should be an important part of your IR rotations. IR is a subspecialty field and we do not expect you to become competent in the performance of complex procedures during the course of your medical student elective rotation.  However, you will be expected to participate in procedures throughout the elective. You should prepare for each procedure by reading about the disease process, indications and contraindications for the procedure, basic technical aspects of the procedure, and postprocedural care. Knowledge of relevant anatomy will be important.

The intent of the IR rotation is to enable you to acquire an understanding of the role of IR in a variety of medical conditions, to obtain a basic set of technical skills, and to develop an interest in this exciting subspecialty of radiology.

Questions always arise as to which procedures are appropriate for medical students or which procedures are expected to have medical student participation.  The answers to those questions differ based on the experience, interest, and proficiency demonstrated by each individual student during their IR rotations.  You will be working one-on-one with faculty and fellows when performing procedures.  In general, your goal should be to spend your first few days on the rotation observing procedures.  Then you can begin gaining comfort with the more basic procedures that are performed in IR.  As you demonstrate proficiency with these procedures, you will be given additional opportunities to increase your role in more complex procedures. Although you will have opportunities to assist and observe, you will never be in a procedure without the direct supervision of a physician or nurse practitioner. 

At many times during the day, you will wonder whether or not it is appropriate to participate in a procedure.  You are expected and encouraged to participate in any procedure that is of interest to you. In more interesting and complex cases, you may find that a resident, fellow and attending will be scrubbed into the procedure; in these scenarios your role may be observational.  In other cases, you will observe procedures being performed by a nurse practitioner without any house-staff assistance.  Our nurse practitioners are acknowledged as experts in venous access and are equally skilled in other areas of IR.  An opportunity to work directly with our NPs may be one of the better teaching experiences you encounter on your rotation and your participation in these procedures is encouraged.  Finally, you will see procedures being performed by attendings without any house-staff assistance.  It is always OK for you to scrub into these procedures and you are encouraged to do so.  Any time you decide to not participate in a procedure, you are passing up an educational opportunity and an opportunity to develop your procedural skills.

After completing your rotation in IR, we expect that you will have participated in the following procedures:

  • 3 CT or ultrasound guided biopsies
  • 3 CT or ultrasound guided abscess drainages
  • 2 ultrasound guided paracentesis procedures
  • 2 ultrasound guided thoracentesis procedures
  • 2 venous access device placement procedures
  • 1 dialysis graft/fistula management procedure
  • 1 IVC filter placement
  • 1 arterial embolization procedure

The IR service is involved with many different types of procedures and the procedures listed above represent only a small percentage of them.  We encourage you to participate in a variety of procedures during your rotations as it is important to gain an understanding of the breadth of this specialty.  If you scrub into a minimum of 2 procedures/day, that will add up to 40 procedures during each 4-week rotation.  In fact, you should have the opportunity to participate in more than 2 procedures/day, which will give you ample opportunity to gain hands-on experience in this area of radiology. 

It is our expectation that you enter every case you are involved with into New Innovations so that we can review your procedure log at the end of each rotation.  In this way, we can help make sure that you complete the procedural expectations listed above. 

In order to provide you with the most comprehensive experience possible, it is preferable that you perform the pre-procedure evaluation alongside the resident or fellow prior to procedures that you will be performing.  Similarly, you should be familiar with the post-procedure responsibilities in association with a procedure you perform. You should try and identify procedures that you may be interested in performing the day before the procedure since this will allow you to read about the anticipated procedure(s) before you scrub in. 

If at any point you feel that you are being asked to spend a disproportionate amount of your time seeing inpatients without participating in procedures, then you must let one of our attendings know and we will reassign responsibilities to allow for more procedural opportunities. 

Post-Procedure Responsibilities

Our involvement in the care of patients after IR procedures is important for continuity of care.  It cannot be expected that anybody but a member of the IR team will understand the potential issues that patients may face after one of our procedures.  Therefore, follow-up for both inpatients and outpatients must be insured so that these patients receive appropriate care from our service.  Outpatients are often followed up in our IR clinic and appointments are given to patients for follow-up before they leave the department.

For inpatients, you are expected to work alongside our fellows and residents during evening rounds as they see the patients who had procedures performed earlier that day.  An additional progress note should be entered into the chart at that time.  Evaluating inpatients at the end of the day is meant to be a shared responsibility between the fellows and residents. You are not expected to evaluate patients independently before or after a procedure. 

Call

Medical students rotating on IR are not required to take call. 

Clinic

The IR service at AMC was one of the first departments to establish an outpatient IR office and to use that office to facilitate the assumption of responsibility for all aspects of patient management surrounding IR procedures.  Today, the office is located at the Capital Region Health Park at 711 Troy Schenectady Road (Suite 113) in Latham.  Many new patients are seen in consultation in the office and established patients are seen in follow-up after their procedures.  In addition, some image-guided procedures are performed in that office setting.  Spending time in our outpatient office is not a requirement for medical students rotating on IR.  However, medical students interested in pursuing IR are encouraged to spend at least one day in the office.

Academic Expectations

Reading

The clinical experience while on the interventional radiology elective must be augmented with reading.  The recommended textbook is Vascular and Interventional Radiology: The Requisites, Second Edition (Kaufman). This textbook can be accessed electronically through Schaffer Library and can also be borrowed in hardcopy from our library next to the IR scheduling office. You will also find the Handbook of Interventional Radiologic Procedures (Kandarpa) to be a valuable resource while on rotation. A list of recommended articles has also been compiled for your education. Please see Rachelle for more information. While on the IR rotation, medical students will be participating in procedures every day.  It is our suggestion that each night, the medical student should read either a book chapter or pertinent article concerning 1-2 procedures they were involved with during that day and 1-2 procedures they will be involved with on the following day.  By focusing the reading in this manner, it becomes very pertinent and easier to understand. 

 Required Conferences

1)    Morning Conferences: IR gives teaching conferences to the residents on Tuesday or Wednesday mornings from September-May.  It is always expected that medical student attend these conferences.  The conference schedule will be provided to you at the start of the rotation.  As mentioned, there is a reading list available which corresponds to these conferences.

2)    Morning Rounds: Board rounds begin at 7:30 every morning and is followed by walking rounds. It is expected that medical student on the IR service arrive promptly and actively participate in morning rounds.

Evaluations

All members of the IR staff will monitor your progress on IR.  Your performance will be evaluated through direct observation during rounds, conferences, and procedures, one-on-one interaction with attendings concerning evaluations and procedures you are involved with, and 360-degree evaluations completed periodically by all members of the IR staff (including physicians, technologists, nurses, and nurse practitioners).  Errors observed during the procedure will be pointed out and discussed as they are recognized and we expect that you will rectify and learn from these experiences, incorporating feedback into improved performance. 

Written evaluations will be completed in New Innovations following the completion of each rotation.  IR is uniquely suited to evaluate medical students in all 6 of the general competencies that are part of training in every specialty, including patient care, medical knowledge, interpersonal communication skills, professionalism, practice-based learning and improvement, and systems-based practice.  The evaluations we complete in New Innovations will reflect our assessment of you as it concerns each of these competencies as well as with the goals and objectives as listed below. 

Case Presentation

During the final week of your IR rotation, you will be expected to give a 5-7-minute presentation on an interesting case of your choice. The case you choose should be one in which you participated in or observed. The presentation will be held in the IR suites following 7:30 rounds and should include the following:

  • Brief history and physical
  • Relevant laboratory data and imaging findings
  • Procedure performed including technical details
  • Procedure indications and contraindications
  • Patient outcome
  • Discussion of relevant literature 

The case should be reviewed with a fellow or attending prior to presentation.