During their PGY-2 through PGY-4 years, Maine Medical Center (MMC) IR residents are provided protected time to attend didactic activities daily from 7-8 AM and 12-1 PM (12-2 PM on Thursdays). This results in 11 hours of protected time every week (the ACGME only requires 5 hours/week). The didactic curriculum includes interactive conferences in addition to the core didactic series. Didactic activities include, but are not limited to: lectures, conferences, courses, labs, asynchronous learning, simulations, drills, case discussions, grand rounds, didactic teaching, and education in the critical appraisal of medical evidence.
The residents deliver bimonthly didactic conferences based on Fundamentals of Diagnostic Radiology by Brant and Helms, and IR residents participate in these conferences during their PGY 2-4 years.
The didactic curriculum also includes interdisciplinary conferences in which both residents and faculty members participate on a regular basis. Conferences provide for progressive resident participation.
Due to the COVID-19 pandemic, the program now provides mechanisms for residents to participate in all didactic activities either in-person or by electronic means.
During July and August, all PGY-2 IR residents receive dedicated lectures daily from 7-8 AM that introduce them to the specialty of radiology:
Abdominal (gastrointestinal and genitourinary) radiology:
- Managing contrast reactions
- CT protocols/imaging limitations and indications
- Intro to fluoro
- Abdominal anatomy/how to read an abdominal CT
- Basics of body MRI
- GU/GI MRI
- Intro to abdominal trauma CT
- Abdominal anatomy at the workstation
- Foreign bodies
Cardiothoracic (cardiac and thoracic) radiology:
- Intro to chest x-ray
- Emergencies in thoracic imaging
- How to read a chest CT
- Arterial/venous access
- Skeletal trauma
- Head and neck anatomy
- Brain anatomy
- CNS infection
- Neurovascular anatomy/pathology
- Head and spine trauma
- Spine anatomy
Nuclear radiology and molecular imaging:
- Intro to planar/SPECT
- Intro to PET
- Intro to pediatric fractures
- Intro to peds chest
- Intro to peds abdomen
- Vascular ultrasound basics
- Intro to ultrasound
- Intro to pelvic ultrasound
- Body ultrasound
- How to be an outstanding radiology resident
- How to formulate an effective radiology report
- How to take cases in conference
The core didactic curriculum is repeated at least every two years, with a goal to repeat it on a 1.5-year cycle so that residents can be exposed to all essential topics twice before the ABR Core Examination in June of the PGY-4 year.
Each of the following practice domains is represented in the core curriculum:
- Abdominal (gastrointestinal and genitourinary) radiology
- Breast radiology
- Cardiothoracic (cardiac and thoracic) radiology
- Interventional radiology
- Musculoskeletal radiology
- Nuclear radiology and molecular imaging
- Pediatric radiology
In addition to the practice domains, there is didactic content in the following educational areas:
The core didactic curriculum includes the following diagnostic radiology content:
- Anatomy, disease processes, imaging, and physiology
- Specialty/subspecialty clinical and general content
- Topics related to professionalism, physician well-being, diversity, and ethics.
- Training in the clinical application of medical physics distributed throughout the 60 months of the educational program:
- A medical physicist oversees the physics curriculum, which includes real-time expert discussions and interactive educational experiences
- A minimum of 80 hours of classroom and laboratory training in basic radionuclide handling techniques applicable to the medical use of unsealed byproduct material for imaging and localization studies and oral administration of sodium iodide I-131 for procedures requiring a written directive:
- Integral to the practice of nuclear radiology, these didactics include, at a minimum, the following subjects:
- Radiation physics and instrumentation
- Radiation protection
- Mathematics pertaining to use and measurement of radioactivity
- Chemistry of byproduct material for medical use
- Radiation biology
- Integral to the practice of nuclear radiology, these didactics include, at a minimum, the following subjects:
The core didactic curriculum includes the following core content areas of IR:
- Focused history and physical examination
- Health care team coordination
- Informed consent for IR procedures
- Inpatient care
- IR clinic
- Medical conditions relevant to IR procedures
- Pharmacology relevant to IR
- Procedural sedation for IR procedures
- Recognition and initial management of intra- and peri-procedural emergencies
Imaging and image-guided procedures are integral to the management of cancer, and so radiology is represented at nearly all interdisciplinary tumor conferences at Maine Medical Center. These include breast, upper GI, lower GI, gynecology, leukemia/lymphoma, liver, lung, melanoma, neuro oncology, pediatric, and urology/prostate. The majority of these conferences are inter-professional, with attendees including physicians, residents, physician assistants, and nurse practitioners from multiple specialties; medical students; nurse navigators; and other health care professionals. IR residents are expected to attend the tumor conference that is pertinent to their rotation at the time.
Furthermore, each division in the MMC Department of Radiology holds QI/QA conferences twice a month that include all health care professionals who work in that division (e.g. technologists, nurses, administrators, physicians, etc.). IR residents are expected to attend at least one of the two monthly QI/QA conferences that is pertinent to their rotation at the time.
Finally, the IR nursing and technologist staff participate in our monthly IR Mortality & Morbidity (M&M) conferences.
Among the interdisciplinary/interprofessional conferences that IR residents attend is the monthly Rad-Path conference, during which IR residents prepare and present clinical- and pathologically-proven cases.
The MMC IR residents regularly participate in a journal club. Every month, one of the residents chooses a journal article, and leads a discussion about it with his or her colleagues at one of their conferences.
Morbidity and mortality (M&M) related to the performance of interventional procedures is reviewed during a monthly conference. Residents actively participate in this review.
Residents at Maine Medical Center are required to obtain three hours of pain management education every two years. All of our residents attend lectures on pain management (including recognizing the signs of addiction) during PGY-1 orientation. MMC is currently developing a standardized, tiered curriculum on Canvas to help satisfy the ongoing requirement beginning in PGY-3. In the interim, our residents are provided with a list of free online modules on pain management in order to obtain their continuing education. Live courses are available locally as well.
PGY-4 IR residents take the Four Week Radiologic Pathology Correlation Course at the American Institute for Radiologic Pathology (AIRP) in Silver Spring, MD, just outside Washington, DC. This course presents a comprehensive review of radiologic imaging with emphasis on the principles of radiologic-pathologic correlation. Approximately 95 percent of U.S. radiology programs attend the course at some point during their training. Additionally, a large number of radiology residents and fellows from Canada, Spain, Switzerland, the Netherlands, Asia, and South America regularly attend the course.
RPVI Exam Prep Course
The Registered Physician in Vascular Interpretation (RPVI) credential was developed for physicians who practice in the noninvasive vascular laboratory, and provides a standardized certification that validates a physician’s expertise in interpreting the full spectrum of diagnostic information from vascular ultrasound and testing. This ultrasound credential from the Alliance for Physician Certification & Advancement (APCA) is considered the global standard.
For interventional radiologists, reading noninvasive vascular studies is a critical component to managing patients with peripheral vascular disease. The Physician’s Vascular Interpretation (PVI) exam provides a credential that is recognized by accrediting bodies such as the Intersocietal Accreditation Commission (IAC). Having this credential satisfies some of the requirements required by physicians to read in accredited noninvasive laboratories. The PVI exam tests knowledge of clinical ultrasound physics and interpretation skills.
RPVI is currently a prerequisite for taking the Vascular Surgery Qualifying Exam, and may eventually be required for IR/DR certification by the American Board of Radiology (ABR) as well.
Several RPVI exam prep courses are offered, but the most convenient is a day-long course at the Society of Interventional Radiology (SIR) Annual Scientific Meeting. MMC IR residents are allocated time and financial support to attend an RPVI exam prep course during their PGY-5 or PGY-6 year. They are then expected to take the PVI examination in order to obtain this credential by the time they complete their residency training.
The Society of Interventional Radiology is developing a standardized online curriculum called “Fundamentals”, which is a pre-requisite to Residency Essentials (described below). These modules, which include topics on clinical medicine, intensive care medicine, image-guided interventions, and imaging and anatomy, are anticipated to be released in fall 2020 for residents to complete at their own pace during PGY 2-4.
The MMC Integrated IR Residency Program will utilize Residency Essentials to meet the ACGME requirement for 2 hours of conferences/lectures per week during PGY 5-6 (see below). Residents will be provided with protected time to participate in these activities.
IR residents are also expected to continue to participate in Liver Tumor Board, Journal Club, and IR M&M throughout PGY 5-6.
If PGY 5-6 IR residents are not busy seeing patients, performing procedures, or otherwise involved in the activities of the procedural team, they may also attend the other lectures described above with permission from their IR attending.
IR residents help to educate medical students, diagnostic radiology residents, fellow IR residents, and visiting residents from other specialties while rotating on the IR service throughout their training, with accelerating expectations over time. This clinical education includes the care and management of patients.
IR Morning Rounds
The MMC IR team (physicians, PAs, residents, and medical students) rounds every morning from 7:30 – 8 AM in the IR Reading Room in order to discuss our patients. Many procedures are performed by the first available provider in the first available room, and so it is important that the entire team be familiar with the details. All patients who are scheduled for procedures that day as well as patients on whom we performed procedures that we are still following are discussed.
All residents (regardless of whether IR or DR) and medical students rotating on IR are assigned the task of reviewing and presenting the patients at morning rounds. Time necessitates that this is a well-organized presentation. Trainees spend time prior to morning rounds reviewing the consultation, diagnoses, problem lists, allergies, medications, laboratory evaluation, and the results of imaging.
For the PGY 5-6 years, the Society of Interventional Radiology has developed a standardized online curriculum called “Residency Essentials” that launched on 7/1/20. This consists of 4-6 hours of “Clinical Topics”, which include recorded didactic lectures and articles, pre- and post-assessments, and additional resources on gastrointestinal, genitourinary, men’s health, neurological, oncology, pain and palliation, pediatric, vascular, and women’s health. There will also be “Requisite Knowledge” modules on business and law, systems, physician wellness and development, and research and statistics that are anticipated to be released in fall 2020 for residents to complete at their own pace during PGY 5-6.
The MMC Integrated IR Residency Program will utilize Residency Essentials to meet the ACGME requirement for 2 hours of conferences/lectures per week during PGY 5-6.