Goals and Objectives: Cardiac Nuclear Medicine
(1 Year Curriculum-Nuclear Residency Program)
Description of Rotation or Educational Experience
The one year curriculum emphasizes cardiac nuclear medicine training because the
graduate of a radiology residency has only had very basic exposure to this rotation. The
goal in the first three months is to provide the fundamentals of cardiac nuclear medicine
practice, including the general principles of radiotracer imaging and familiarity with the
range of diagnostic imaging studies and stress testing procedures. There is hands-on
experience with patient interviews and stress testing modalities. Over the following nine
months, there will be increased familiarity with cardiac nuclear medicine imaging.
Residents are expected to function largely independently (with appropriate supervision)
in prescribing, performing and assessing adequacy, interpreting and reporting cardiac
nuclear medicine imaging studies. The residents should by now have knowledge of the
integration of other non-invasive cardiac studies and diagnostic algorithms.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health.
Objectives
In the first 3 months, residents are expected to:
1. Learn to care appropriately for patients while they are in the Nuclear Medicine
suite for cardiac nuclear imaging studies.
2. Communicate effectively with patients during the interview, so that an
appropriate history and physical examination can be obtained. Obtain information
from medical record and clinical physicians.
3. Learn how to monitor patients who are undergoing stress testing on the treadmill
and with pharmacologic agents.
4. Learn the treatment of complications of stress testing, including the ability to
interpret electrocardiograms and perform cardiopulmonary resuscitation.
5. Learn the contraindications for stress testing and modifications for special patients
and be able to select appropriate stress testing procedures.
After the introductory period, residents are expected to:
1. In addition to all the above, become more sophisticated and independent in the
care of cardiac patients in the cardiac nuclear medicine laboratory.
2. Demonstrate more advanced skills in patient care (history, physical examination,
treatment of complications).
3. Demonstrate facility with hospital computer and PACS systems for patient care.
4. In short, be able to take responsibility for almost all routine patient management
while the patient is in the cardiac nuclear medicine laboratory.
5. During the residency, have hands-on experience with stress procedures (exercise
and pharmacologic) of a minimum of 50 patients.
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Medical Knowledge
Goal
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and cognate (e.g. epidemiological and social-behavioral) sciences, and
the application of this knowledge to patient care.
Objectives
In the first 3 months, residents are expected to:
1. Learn the main imaging modalities, planar, SPECT and PET and appropriate
radiopharmaceuticals for cardiac nuclear medicine.
2. Learn the indications for various cardiac nuclear medicine studies.
3. Learn basic aspects of quality control, acquisition and computer processing of
images (myocardial perfusion, radionuclide ventriculography, PET viability
studies).
4. Develop skills to interpret cardiac nuclear medicine studies, formulate
differential diagnoses and draft reports.
5. Demonstrate fundamental skills with patient interviews, stress testing
protocols and possible complications and treatment thereof.
6. Learn important aspects of electrocardiographic interpretation.
7. Learn the pharmacology of cardioactive drugs.
After the introductory period, residents are expected to:
1. Acquire increasingly sophisticated knowledge of the imaging and nonimaging modalities, radiopharmaceuticals, and scintigraphic appearance in
cardiac nuclear medicine studies.
2. Have acquired advanced skills with patient interviews, stress testing protocols
and possible complications and treatment thereof.
3. Accurately dictate reports and communicate results in cardiac nuclear
medicine with reduced supervision.
4. Demonstrate facility with independently running the cardiac nuclear
laboratory (with reduced level of supervision).
5. Learn the role of other non-invasive cardiac studies (e.g. cardiac CT) and
diagnostic algorithms for diagnosis of coronary artery disease.
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to perform practice-based learning and
improvement that involves investigation and evaluation of their own patient care,
appraisal and assimilation of scientific evidence, and improvements in patient care.
Objectives
Residents are expected to develop skills and habits to be able to:
1 Utilize available information technology for access to the most recent scientific
data. Independently seek out new data in printed and electronic formats.
2 Collect cardiac cases of interest, either due to unusual or classic presentations of
disease or due to difficulties in diagnoses. Present these at the nuclear medicine
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correlation conferences.
Participate in Journal Club where appraisal of scientific evidence and applicability
to patient care of cardiac patients are discussed.
Participate in annual self-assessment exercise, identify strengths and limitations
and develop own learning goals with regard to cardiac imaging.
Systems Based Practice
Goal
Residents must be aware of systems-based practice, as manifested by actions that
demonstrate an awareness of and responsiveness to the larger context and system of
health care, and the ability to call effectively on system resources to provide care that is
of optimal value.
Objectives
Residents are expected to:
1. Fully understand the relative merits of the different cardiac nuclear medicine
imaging studies and able to make recommendations to the clinical service
concerning the best imaging studies for detecting suspected pathology.
2. Demonstrate basic knowledge about the costs of cardiac imaging studies. Play an
active role in trying to control health care cost expenditures. This includes
recommending equally effecting imaging studies that are less expensive,
whenever appropriate.
Professionalism
Goal
Residents must demonstrate professionalism, as manifested through a commitment to
carrying out professional responsibilities, adherence to ethical principles, and sensitivity
to a diverse patient population.
Residents are expected to::
1. Dress appropriately at all times.
2. Interact on a professional level with their cardiac patients, demonstrating great
sensitivity toward their patients’ anxiety, and placing appropriate and
compassionate patient care above self-interest at all times.
3. Demonstrate strong ethical principles. This includes good work ethic with prompt
appearance on the cardiac service at appropriate times.
4. Establish professional relationships with the nuclear medicine technologists and
student technologists with whom they interact and progressively develop team
leader skills.
5. Not discriminate based on age, ethnicity, gender, disability or sexual orientation.
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in
effective information exchange and collaboration with patients, their families, and other
health professionals.
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Objectives
Residents are expected to (to be):
1. Able to verbally communicate the results of cardiac studies concisely and clearly
to inquiring referring physicians.
2. Gain mastery of report dictation. Dictate cardiac nuclear medicine study findings
clearly and concisely and summarize those findings effectively in an impression
with minimal direction
3. Develop an ability to communicate calmly and clearly explain the nature of
cardiac nuclear medicine imaging studies to patients. Demonstrate appropriate
patience and empathy in this communication.
4. Able to communicate effectively with technologists, patients and clinical
physicians with whom they interact. This includes demonstrating leadership
skills.
Teaching Methods
Formal, didactic lectures on cardiac nuclear medicine including EKG interpretation and
pharmacologic stress agents
Small group teaching on individual cardiac cases
Conferences and Journal Club on cardiac nuclear medicine topics
Teaching files on service, teaching files on internet
Written material in textbooks; scientific articles provided by faculty
Hands-on teaching for stress testing methodology
Self education is expected
Assessment Method (residents)
Focused direct observation by the faculty (written quarterly evaluations)
Assessment of residents’ draft reports
Assessment of presentations
In-house examination
In-training ABNM examination
Assessment by clerical and technologist team members
Self-assessment tool
Resident logs (diaries) to document the experience with 50 stress test patients.
Assessment Method (Program Evaluation)
Annual formal program evaluation
Quarterly meetings with the Program Director
Frequent informal discussions with the Associate Program Director
Level of Supervision
During the first three months supervision by the faculty is direct. During the following
nine months, residents take on greater responsibility including supervision of radiology
residents, quality control of images, appropriateness review. Responsibility continues but
dictated reports are always reviewed by the faculty. The faculty decides as a group
whether the resident has sufficient knowledge and skills to be promoted to “Supervisory
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Fellow” at which time responsibility is given to “run” the service (with reduced
supervision by the faculty).
Educational Resources
Textbooks in the Fellow Library
Taubman Medical Library
Electronic Teaching File
Access to Internet, Medline Search and PubMed
4/05/07
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