RADU-4007 - Breast Imaging

RADU-4007 - Breast Imaging

Elective Title: Breast Imaging
Course Number: RADU-4007
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Compltetion of Internal Medicine and Surgery Clerkships
Responsible Faculty Director: Flavia E. Posleman Monetto, M.D. Periods Offered: 1-7; 9-13 excluding holiday period 8 
Coordinator: Lycia Champagne-Buckley Other Faculty: Angel Robinson, MD;
Location to Report on First Day:
Lycia Champagne-Buckley, lcchampa@utmb.edu

This rotation is designed to increase the students expertise in the management of breast complaints. Students will become acquainted with the various imaging modalities used in the diagnostic workup of breast patients. Familiarity with breast imaging concepts and breast pathology is to be expected.

At the end of the four-week elective, the student should be able to:
1. Make a judgment as to which imaging is indicated in the diagnostic workup of breast symptoms.
2. Have some insight regarding certain limitations of various imaging modalities.
3. Understand the anatomy depicted on mammograms, breast ultrasounds and the general concept of breast MRI. 4. Recognize standardized terminology in breast radiology interpretation. 5. Better appreciate the spectrum of breast pathology and how it correlates with breast imaging.
6. Have a general concept of routine breast imaging interventional procedures.

Description of course activities
The student will have the opportunity to observe and work closely with faculty, residents and technologists in the production and interpretation of diagnostic images. Additionally, students will observe interventional breast procedures and become familiar with the basic concepts of ultrasound guided procedures. Each day approximately 20 to 35 patients are evaluated for abnormal breast symptoms or abnormal mammogram findings and there are approximately 40-50 screening mammograms interpreted on a daily basis. Also, various interventional breast procedures are performed each week. Finally, 5-10 cases are presented at a weekly multidisciplinary breast health tumor board, and this allows students to see pathological correlation and get insight from various specialties including breast surgery, plastic surgery, radiation oncology, medical oncology and pathology regarding the management of breast cancer.

Type of students who would benefit from the course
This course is especially valuable to the student set who are contemplating a career in surgery, radiology, oncology, radiation oncology, plastic surgery, family medicine, women's health and ob/gyn. However, the basic understanding of breast disease which is derived from this course will prove beneficial to most medical generalists and specialists.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8.30 5.00
Tuesday 8.30 5.00
Wednesday 8.30 5.00
Thursday 8.30 5.00
Friday 8.30 5.00
Saturday 0 0
Sunday 0 0

 Average number of patients seen per week: 325
 Call Schedule: N/A

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    All day
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Some short subject to the Breast imaging conference.
  B. Frequency / Duration of Presentation(s)?
    Once a month.
  C. Format - What guidelines are set for the student's presentation?
    None - informal discussion of selected topics.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    All of the above mentioned.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    The student is evaluated solely on the basis of daily observation by faculty. Punctuality, attendance and performance of designated responsibilities are expected. There will be no examinations.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.