Rationale and Objectives
The Accreditation Council on Graduate Medical Education (ACGME) through its Outcome Project requires training programs in all medical specialties to integrate six general competencies into residency training: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice. In response, a required, or dedicated general competencies rotation for diagnostic radiology residents was instituted.
Materials and Methods
We describe the development and implementation of this rotation. The rotation augments the core curriculum, with primary emphasis placed on resident-initiated quality improvement (QI) and quality assurance (QA) projects.
Results
Between academic years 2003 and 2009 diagnostic radiology residents completed 38 QI/QA projects and performed clinical float coverage for the department. Residents met requirements of the systems-based practice and practice-based learning competency domains. In this process, residents improved their medical knowledge, interpersonal communication skills, professionalism, and provided patient care.
Conclusions
A dedicated general competencies rotation can be successfully implemented, and complement the requirements of the core curriculum. In combination with coverage for clinical services, the rotation makes a substantive contribution to resident education to further the goal of improved patient care.
The Accreditation Council on Graduate Medical Education (ACGME) through its Outcome Project requires training programs in all medical specialties to integrate six general competencies into residency training: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice . The Outcome Project initiative has been phased in since 2001 with the expectation that after June 2011, full integration of the general competencies into program curricula will have occurred . In 2005, the Radiology Residency Review Committee revised training program requirements with input from the American Medical Association , American College of Radiology (ACR), and the American Board of Radiology, as well as the Association of Program Directors in Radiology . The new requisites include teaching and assessment of the six general competencies; curriculum innovation is encouraged. This article describes ongoing curriculum development and implementation of a general competencies rotation into the diagnostic radiology residency program of our department. The rotation augments the core curriculum, with primary emphasis placed on resident-initiated quality improvement (QI) and quality assurance (QA) projects.
Methods
Rotation Design
In response to the ACGME Outcomes mandate, an 8-week rotation designed to address components of the general competencies was created as a requirement of the core curriculum for University of Washington diagnostic radiology residents in 2003. Sited in Seattle at Harborview Medical Center (HMC), the major level 1 trauma center in a five-state region, the main program objective was to immerse residents in QI and QA processes. Support for the rotation is provided by the radiology department and institution to enhance the mission of HMC, not only as a major trauma center, but also as a safety-net hospital. As a safety-net hospital, HMC provides health care for the poor, uninsured, and most vulnerable in the community it serves . The volume and patient mix of this busy trauma center broadens learning opportunities for residents. The HMC emergency department (ED) radiologists and workstations are located physically within the ED. Residents gain enough exposure to operations in the radiology department, ED, and hospital to become cognizant of system shortcomings, problems, and redundancies—all potential topics for QI/QA projects.
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Table 1
Selected Resident Projects Completed During Dedicated Competencies Rotation (2003–2009)
Year Title Presentation, Publication, and Outcome 2003 Resident versus attending errors on trauma chest films Presented at AUR (San Francisco, 2004). Co-Winner of the Best Resident Paper Award 2003 Resident errors on after-hours neuroradiological exams, including impact of error on patient management and outcome Presented at AUR (San Francisco, 2004). Co-Winner of the Best Resident Paper Award 2004 Reviewed and presented issues regarding informed consent; reviewed and revised HMCRAD policy on contrast extravasations in CT Now implemented HMC 2004 Resident error patterns in diagnosing cervical spine injuries after hours Presented at AUR (Montreal, Canada, 2005). Winner of the Memorial Award 2005 Resident and attending errors on thoracolumbar spine radiographs and CT Presented at AUR (Austin, TX, 2006) 2005 Yield of CT KUB (noncontrast abdominal CT) in emergency and urgent care clinic patients presenting with flank pain Didactic: Findings on CT KUB in patients with stones 2005 Assessing for mediastinal hematoma: a tutorial Presented as Education Exhibit at ARRS (2006). Winner of the Silver Medal 2005 Evaluation of Subarachnoid Hemorrhage: CTA versus DSA in the detection of aneurysms Presented as scientific exhibit at AUR (Austin, TX, 2006); Presented at ASNR (San Diego, CA, 2006) 2006 Head CT in minimal and minor head injury Pilot data for larger IRB-approved research 2006 Screening for cervical spine injury in low risk patients Pilot data for larger IRB-approved research 2007 Usefulness of CT in assessing injuries to the globe Presented at RSNA (Chicago, IL, 2007) as “The role of CT imaging in the diagnosis of globe injuries”; published in: Contemporary Diagnostic Radiology 2007 Resident interpretation errors on emergency department abdominal/chest CT Electronic poster presentation at RSNA (Chicago, IL, 2008); Published in Academic Radiology 2007 Triaging patients with nontraumatic intraparenchymal hemorrhage Poster and scientific presentation 2007 Utility of repeat head CT after blunt head trauma with intracranial hemorrhage Winner ASER scientific presentation (2009); IRB-approved research 2008 Utility of the radiographic evaluation of ventricular shunts in the emergency department at Harborview Medical Center Presented at AUR (2008); IRB-approved research 2008 An analysis of tunneled catheter-associated infections at Harborview Medical Center: natural history and opportunities for improvement Presented at HMC IR rounds 2008 Overnight interpretation of torso CT at a level 1 trauma center: analysis and review of the literature Presented at AUR; Published in Academic Radiology ; winner of the 2010 Stauffer Award (Best Education Paper) 2008 Negative appendectomy rate and imaging at Harborview Medical Center Presented at AUR; IRB-approved research 2008 Radioiodine treatment of benign hyperthyroidism: outcomes from a county hospital population treated between 2000 and 2006 Presented at AUR; second study presented at SNM 2009 SPOX (surgical postoperative x-ray): Preventing retained surgical material at Harborview Medical Center Creation of macro in reporting SPOX 2009 Use of serial CTs in traumatic hemorrhagic brain injury: a qualitative and quantitative analysis Pilot; IRB-approved research 2009 Structured reports in ER CTA neck stroke protocol reports; utility of structured reports in ER and outpatient spine CT reports Used for online protocols 2009 MRI reporting for low back pain studies Pilot; ongoing study; RSNA research award 2009 Clinical utility of routine chest radiographs for intubated patients at Harborview Medical Center Presented at ARRS (San Diego, CA, 2010); Winner of the ARRS Executive Council Award
ARRS, ; ASER, ; ASNR, ; AUR, ; CT, computed tomography; CTA, ; DSA, ; ER, ; HMC, ; HMCRAD, ; IR, ; IRB, institutional review board; KUB, ; MRI, magnetic resonance imaging; RSNA, .
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Prerotation
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Orientation
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Project Design and Data Acquisition
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Project Completion and Dissemination
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Assessment
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Results
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Discussion
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Table 2
ACGME General Competencies in Relation to Performance Objectives
ACGME, Accreditation Council on Graduate Medical Education; HSR, Health Services Research; IRB, institutional review board; QA, quality assurance; QI, quality improvement.
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Conclusion
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Supplementary data
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Appendix
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