RADU-4023 - A/I Internship: Interventional Radiology

RADU-4023 - A/I Internship: Interventional Radiology

Elective Title: A/I Internship: Interventional Radiology
Course Number: RADU-4023
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: Completion of RADU-4006 Interventional Radiology Elective
Responsible Faculty Director: Eric Walser, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Lycia Champagne Other Faculty: Arsalan Saleem, MD; Irfan Masood, MD; Farhan Ahmad, MD; Obadah Ezzeldin, MD; Ahmed Khan, MD
Location to Report on First Day:
Lycia Champagne-Buckley, lcchampa@utmb.edu; LCC Radiology 1st floor

To introduce the student to interventional radiology procedures and imaging relevant to procedures and patient care. Focus will be on men's health and surgical collaboration.

1) Become familiar with indications/contraindications for various procedures in Interventional Radiology 2) Learn to review imaging studies and form a plan for image-guided interventions 3) Learn to evaluate and manage patients before and after procedures 4) Perform procedures under the supervision of IR faculty.

Description of course activities
The Interventional Radiology section of the Radiology Department at UTMB offers electives for medical students. This elective is clinically oriented. Inpatients are followed on the ward, and outpatients are followed by outpatient visits. Inpatients are occasionally admitted to the Interventional Radiology service. The student actively participates with the rest of the Interventional Radiology team and becomes familiar with the procedures, the techniques, and care of the patient. Urologic procedures and men's health are emphasized on this rotation.

Location will be all UTMB hospitals (main, LCC, CLC, ADC) as determined by IR faculty, so some travel is required.

Type of students who would benefit from the course
The elective is for students who are considering a career in Interventional Radiology, but that is not a prerequisite. The elective is useful for students who plan on entering an Interventional Radiology residency or plan to enter a specialty which is procedurally oriented, such as ICU medicine, surgery, urology and the medicine subspecialties of cardiology and GI endoscopy.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:30 6:00
Tuesday 8:30 6:00
Wednesday 8:30 6:00
Thursday 8:30 6:00
Friday 8:30 6:00

 Average number of patients seen per week: 120
 Call Schedule: None

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?
    Periodically during the day (3-4 times)
  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?
    Faculty and IR fellows
  B. Frequency / Duration of Presentation(s)?
    1-2 times a week informally in a 15-20 minute sessions at morning board rounds
  C. Format - What guidelines are set for the student's presentation?
    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)?
    After every procedure the student participates and they may be asked to write brief operative notes or H&P for consults
  B. Format - What guidelines are set for the student's written work?
    Students may be asked to write HP on consult patients or post- operative notes. The faculty or fellows will review the notes and discuss with the students.
  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.?
    Case related
  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)?
    Participation in morning rounds, discussions before and after procedures. Students will round with fellows/residents and NP on patient care units. Students attend the same didactic lectures/multidisciplinary conferences that residents attend.

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.
    Students are observed and evaluated during procedures, case discussions and patient interactions.

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.
    Students will be given verbal and written feedback on clinical skills after procedures and consults.

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.
    Students will be able to perform lower risk procedures such as paracentesis, thoracentesis, venous line placement and become adequate in catheter and wire manipulation. Urologic procedures are emphasized.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    first assistant on OR cases in which faculty or fellows are scrubbed in.

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)?
    They will be responsible for rounding on certain patients and presenting in AM rounds. They will close wounds in OR and perform minor procedures such as paracentesis, fine needle aspirations and drain placements, biopsies and tube exchanges. There are hospital limitations that preclude placing orders but will practice telling orders that need to be placed.

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?
    familiarity and experience with minimally invasive procedures in IR.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    If deficiencies are identified a midpoint meeting will be called with the student to discuss ways to improve.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There are 2-4 faculty, one of which is the main attending during each week. They can request clinic time with certain faculty from the chief fellow to gain face time with that faculty.

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.
    Students will interact with the entire IR team of faculty, residents, nurses and technologists who will all provide feedback culminating in written evaluation at the end of the elective.