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Residency Program In Diagnostic Imaging
SUNY Downstate has had a residency program in Diagnostic Radiology since 1976. Currently the program is a collaboration among the Radiology Departments at University Hospital of Brooklyn, Kings County Hospital, and the Brooklyn Veterans Administration Medical Center.
We are proud of the quality of training our program provides to its residents. The assets which make such a high level of training possible include not only our facilities, backed as they are by the resources of New York State (University Hospital), New York City (Kings County Hospital), and the Federal Government (Brooklyn VA Medical Center), but most especially our staff, who are committed to striking an appropriate balance between teaching and patient care. We realize that an atmosphere conducive to teaching doesnt just happen it must be cultivated. The purpose of this Handbook for Radiology Residents is to explain how we do just that. Specifically its goals are three-fold:
The Radiology Residency Program of SUNY Downstate is supported by the Radiology Departments of the following three institutions: University Hospital of Brooklyn, Kings County Hospital, and Brooklyn Veterans Administration Medical Center. Residents in the program will rotate through all these institutions during their four years here.
The goal of the Program is to give a basic education in all forms of imaging, interventional procedures, research, physics, and ancillary skills, including outcome analysis, medical legal, financial and communication skills. With a very large clinical resource of extensive pathology, the program takes full advantage of this strength and is organized in a clinical direction. Through the years of the programs functioning, it has been evident that, on average, 1-2 residents per year will pursue an academic career. The program has never been able to identify these potential faculty members during the interview process. Residents career goals become evident as their training program proceeds. The majority of trainees will enter into Diagnostic Imaging in a clinical private practice.
Over the last twenty-five years, the program has trained over one hundred fifty Radiologists who, in general, remain in the geographic area and represent part of the health care system of greater New York City. As is typical of University programs, approximately 10% of the graduates are in Academic Radiology.UP
1. Provide sufficient volume and variety of case material to ensure that residents are competent in all aspects of radiologic diagnosis, nuclear medicine, diagnostic ultrasound, magnetic resonance, computed tomography, interventional procedures, and the use of other forms of radiant energy.
2. At a minimum, one FTE-equivalent faculty member at the parent and integrated institutions for every resident in training in the program. The faculty will demonstrate motivated excellence in residency training. They will have state-of-art diagnostic instrumentation and expert professional, technical, and clerical support.
3. Educational resources (written and electronic media, conference facilities, libraries, etc.) will be current and readily available at all sites.UP
The initial step in resident selection is the review of potential candidates by the faculty and resident interviewers with an emphasis upon academic excellence for their appointment to the program. Through the interview and finally, the National Intern and Resident Match, six or seven position appointments are made per year (total 28 residents).
Members of the faculty continuously evaluate graduated Resident Responsibility Performance with questionnaire forms returned to the Review Committee of the Department. At least two times a year the Chairman of the department or the Associate Program Director meets with all residents, individually, to review their performance level. Satisfactory performance is praised and/or remedial activities are established in appropriate areas. In addition, following the institutions Graduate Medical Education (GME) format, formal credentialing is established. This is done by a procedural record and by formal examination. This process has been in place for years and has been very successful in establishing appropriate skill levels before a resident has semi-autonomous activity. These auditing techniques have been extremely useful in identifying the occasional resident who requires additional help.
Evaluation of Performance:
1. During the first 6 months of the residency there are monthly evaluations reports given to the Residency Evaluation Committee. After the first 6 months there are evaluations of all residents at all levels 3 to 4 times a year.
2. There is a graduated level of independent activity. A critical evaluation of residents performance on rotations allows increasing levels of independent responsibility to be granted on an individual basis.
3. The Department administers the American College of Radiology In-Service Examination on an annual basis. This exam is mandatory for all residents in each of their four years in the program. (attendings cover all services during the exam). Exam results form the basis of a portion of the residents performance evaluation. The results also help the department determine its effectiveness in teaching.
4. The House Staff supplies the Chairmans Office evaluation critiques of sectional rotations and attending performance as teacher/role model.
5. Chief Resident appointment is a faculty decision influenced by multiple factors and is done by closed ballot.UP
Each member of the House Staff will have his/her performance reviewed at a minimum of two times per year by the Director or the Associate Director of the Residency Program. This is a formal documented process with appropriate records placed in the individual file. Unofficial comments and counseling will be the standard of the Departments activities both by individual divisions and by the "ombudsman" for the staff, the Associate Director of the Residency Program. It is the Departments goal to identify any problems as early as possible and to institute corrective action before any formal process is instituted.
The Resident has full access to his/her personnel file. This will contain the periodic evaluation summaries signed both by the member of the House Staff and by the Director and/or Associate Director of the Residency Program.UP
All resident evaluations by Faculty include consideration of promotion. The Education Committee will discuss negative evaluations. The Program Director and Chair will be advised should the Committee advise a process of adverse action (suspension, probation, termination, and non-renewal of contract for performance reasons).UP
The institutional due process guidelines are appended. In the process of disciplinary actions, this is the methodology to be followeUP
As with any large University program, the Department is divided into sub-specialties based upon organs or technology. This Department has the following divisions: Pediatrics, Neuroradiology, Nuclear Medicine, Angiography/Interventional, Computerized Tomography/MRI, Ultrasound, Abdominal Imaging (GI/GU), Emergency Room, Chest, Bone and Mammography.
This design has developed into a very efficient teaching environment with experts in each area. The residents are assigned to these rotations at various times and durations where their sole responsibility is to that specialty area. After the initial one-month introduction to emergency radiology, sequential rotations are programmed so that there is a repetitive exposure during the residents training program. In addition, the conference and lecture schedule reinforces a continuous teaching program in all areas. This "total immersion" teaching technique has been found to be highly effective in this Department, not only in the education of the residents, but also in their evaluation; highly skilled senior physicians oversee day to day work and the house staffs progress in acquiring basic skills and knowledge. Internally, within the Department, there is a review of the effectiveness of teaching as determined by Resident critiques, the ACR examination, and Board certification.
The diagnostic radiology program is based upon rotations, as the above list of specialty areas illustrates. At the current time, the first six months is spent in basic imaging that will aid the new resident in emergency room clinical services: chest, bone, pediatrics, CT, etc. In addition, there are a series of lectures, audio visual aids and CD ROM self-teaching programs that are designed to support these rotations. The most important of these is the initial introduction during July and August when a "crash course" is given to the housestaff by a physician skilled in ER Radiology. In addition, an integral part of this introduction includes radiation protection and physics. A one-week intensive course pertinent to all the modalities needed by a resident to function in the ER is given, followed by a credentialing exam before allowing ER participation. This is repeated at the end of the year to assess improvement and outcome analysis.
In general, there are one or two residents with each attending during the initial part of their program. The basis of the teaching program is an apprenticeship to the Attending radiologist. Detailed studies are presented. All films are reviewed initially by the resident and then, in consultation with the Attending radiologist. Subsequently, the resident will, after the introductory period, dictate the consultation. The Attending radiologist then reviews the transcribed consultation with the resident and signs off on the exam.
In the second year there is more intensive training in subspecialty areas including Neuroradiology, Sonography, Angio/Interventional, etc. There are repeat rotations through the areas of the first year.
The third and fourth years continue a similar process. As the rotation record demonstrates, the intense aspect of months of rotation in such areas as Neuroradiology, gives a concise and well-organized education in the sub-specialty.
In compliance with the experience required by the Residency Review Committee, the Department of Radiology at the Health Science Center in Brooklyn has required and supported all residents to attend the 6-week course at the Armed Forces Institute of Pathology. The Department pays the course fee.
The teaching of radiologic physics is done in two sections. As an introductory program during their first year, there is an emphasis upon basic aspects of radiation protection. There is a subsequent, in depth course, that extends for nine months as a tutorial and preparation for the written Boards in Radiology. The Division of Physics (seven full time members) gives the course.
Each resident is allowed 4 week of extramural elective time which residents may arrange according to his or her specific interests. Senior residents are allowed 1 week away for conference (2 weeks for chief residents).
Currently the Department in planning to add Fellowship Program in interventional radiology, and abdominal radiology to our already active neuroradiology and mammography fellowship. The increased volume in our number of patient visits has made the creation of these additional positions both practical and advantageous for the institution.UP
The program has the Resident apprenticed to the Attending at the beginning or introduction to an area. At this state of his education the Resident is not permitted to work unless an Attending is there. As the Resident attains more of an independent activity level through his/her training program, Attending review tends to be directed more towards problem cases for the Resident. With multiple Attendings assigned to each division an in-depth coverage program exists with adequate availability for (1) review and (2) consultation. In all rotations the cases are uniformly reviewed by an Attending.
In the State of New York, 405 Regulations limit the activity level of members of the Housestaff for regular duty and off-hour call. The department of Radiology is in compliance both for on-premises activity and any other site of delivery of health care by the member of the housestaff.
The Department, as noted before, utilizes a two-tiered night float. At any one time there is a resident in the first two years and another resident in the last two years on-premises for off-hour call. The call begins at 5:00 p.m. or 10:00 p.m. and is completed the next morning by 8:00 a.m. All cases are reviewed by an attending.
The junior call has the availability of the senior call as the first line support. There is a specialty Attending calls as noted on the master on-call list.
As an additional security system, the two chief residents share the emergency back up call for the unusual circumstances of a major medical crisis (multi vehicle accidents with large numbers of patients being brought to the Emergency Room by EMS). This is part of the "disaster" staffing protocol within the Department. In such instances, the Attendings in Interventional Radiology and Neuroradiology will be called into the Hospital for patient care.
The design of the off hour coverage ensures residents’ security in their ability to adequately perform for their level of training and acknowledges that additional help is immediately available either in-house or by call. This system has been successfully in place for over two decades and has given the Department a reputation of excellent Radiology consultation. It has strengthened the Residents in learning appropriate diagnostic algorithms and taking the responsibility of personally examining the patient in the Emergency Room with the referring physician when patient workup is initially uncertain. This makes the Radiology Residents part of the clinical team and emphasizes their role in integrated patient care. There is close consultation with the Emergency Medicine Department to correlate clinical and radiological findings.UP
Resident instruction and Participation in the Institution's Formal Quality Assurance Performance Improvement Programs
Formal instructions in Continuing Quality Improvement (CQI) are integrated into the residency didactic curricula with instruction by attendings and staff. Resident members sit on both KCHC and UHB Departmental CQI Committees.UP
Residents are full participants in departmental and extra-departmental Radiology Educational fora. This includes attendance and participation in the following:
Residents may borrow books and use the facilities of the Medical Research Library of Brooklyn, our campus library located in the Health Science Education Building (HSEB). In addition, the Radiology Department has its own library in University Hospital, down the hall from the departmental office. Funding has recently been provided to update our departmental library with new textbooks and journals. Furthermore, the department expects to introduce a new CD-ROM archive for use by 2001. This resource will allow faculty and housestaff online access to multiple selected textbooks. Most of the ACR learning files are available on CD for use in the residents call room at Kings County Hospital CenterUP
The Department tries its best to accommodate the needs of all members of the Department regarding religious observances. Exchange of on-call schedules, assignment schedules, etc. are programmed for this purpose.UP
1. The faculty at SUNY Downstate, which includes residents as Assistant Instructors, is governed by the labor agreement between the United University Professions and the State University of New York. There are no specific provisions for either maternity or paternity leave. We try to follow Family Medical Leave Act (FMLA) guidelines "Sick-time" is also utilized.
2. For those members of the house staff not covered under this (at an affiliated hospital), the Committee of Interns and Residents of the City of New York negotiated unlimited maternity leave (without pay), and paternity leave. See the copy of the housestaff contract in the appendix for the details.UP
All House Staff members are expected to dress in an appropriate professional manner. This will require a shirt and tie for the men and comparative dress for women. Since Kings County Hospital Center issues white coats to the House Staff, all House Staff are expected to wear white coats.
The only exception to this would be appropriate O.R. dress in the interventional rotation.UP
1. First year residents are appointed through the University Hospital. All other years are through Kings County Hospital Center.
2. Salaries are (2007-2008)
3. The Department tries to accommodate the specific needs of members of the House Staff such as religious commitments with on-call, maternity, and other personal needs as reviewed by the Department.