Nuclear Medicine
Supervision Policy
(2 Year Nuclear Residency Program)
Introduction
The training of nuclear medicine residents is an important function of the Division of Nuclear
Medicine. Such training can only be appropriately performed if House Officers function within
a system where supervision is clearly defined. There is a balance between allowing trainees
increasing responsibility and autonomy as their residency progresses and maintaining
supervision. Increasing responsibility is desirable so that, upon graduation, residents will be able
to function independently at the level of new providers. Supervision is essential to maintain
excellent patient care in the Division of Nuclear Medicine at all times.
General Principles of Resident Supervision (apply to all rotations)
1.
Each resident must be supervised in his/her patient care responsibilities by qualified
faculty throughout the residency training.
2.
No dictation of a nuclear medicine study on any patient at any time is finalized until
that study has been reviewed and electronically signed by supervisory faculty.
3.
No radionuclide therapy is administered without the direct participation of
supervisory faculty. Therapy dictations are not finalized until that study has been
reviewed and electronically signed by supervisory faculty.
4.
All procedures (e.g. lymphoscintigraphy) performed by residents (day or after-hours)
must be supervised by a faculty member present on the service.
5.
Residents will be given progressive responsibility for clinical duties. The
determination of a resident’s ability to provide care with reduced supervision will be
based upon the written faculty evaluations and review of case logs. The overriding
consideration must be safe and effective care.
6.
In an emergency situation, a resident will be granted permission to do everything
possible to save the life of a patient or to save the patient from serious harm.
7.
The Program Director ensures, directs and documents adequate supervision of
residents at all times.
8.
Residents are provided with rapid, reliable systems for communicating with
supervising faculty (everyone carries a pager at all times).
Job description for the first year of nuclear medicine training (PGY IV/V) and supervision
guidelines
At the outset, residents participate in orientation to policies, procedures and the role of residents.
During the first six months of the first year of residency, trainees have core nuclear medicine
rotations in which they are exposed to the basic nuclear medicine imaging modalities and obtain
hands-on experience during the camera/pharmacy rotation. At this early time they are closely
and directly supervised during patient interactions and when learning the rudiments of report
dictation. Teaching is intensive, in small groups and individually. At the conclusion of the first
six months, the residents should have grasped the basic principles of image interpretation.
Residents continue to apply their newly acquired knowledge to routine imaging under close
faculty supervision (faculty are available throughout the day to review all studies). The faculty
schedules are designed so that one or two faculty members are assigned exclusively to the
supervision and teaching of residents throughout the working day.
During the second six months of training there is more emphasis on complementary rotations,
though the training in general nuclear medicine and PET continues. Rotations at the VA
Hospital, pediatric nuclear medicine, cardiac nuclear medicine, and nuclear medicine therapy
round-out the training. At each site or rotation, residents are supervised by the faculty with
increased responsibility and autonomy granted according to the individual resident’s progress.
For example, the resident may be permitted to decide the adequacy of the images (QC) with a
reduced level of faculty supervision. During the second half of the first year, residents’
increased responsibilities might include supervision of medical students and radiology residents
and performing appropriateness reviews. The faculty meets quarterly as a group and jointly
makes decisions concerning each resident’s progress and his/her required level of supervision.
Description of clinical activities the first year resident may perform
Clinical Activity
Dictate nuclear medicine reports
Perform history and physical
examinations
Perform QC on images
Perform appropriateness review
Prescribe diagnostic radiopharmaceutical
doses
Calculate therapy doses
Perform procedures
Supervise stress tests for myocardial
perfusion studies
Obtain informed consent for stress
testing
Supervisory Level by Faculty
Direct contact
Without physical presence but in-house available
supervisory
In-house available supervisory
Without physical presence but in-house available
supervisory
In-house available supervisory
Direct contact
Direct contact
Direct contact graduating to without physical
presence (in-house availability)
Without physical presence but in-house available
supervisory
Description of teaching activities the first year resident may perform
1.
2.
Supervise clinical care and education of third year medical students
Teach radiology residents. Supervise radiology residents (second half-year)
Job description for the second year of nuclear medicine training (PGY V/VI/VII) and
supervision guidelines
During the second year, resident responsibility on the nuclear medicine service increases. On the
general service the residents are expected to review the emergent cases from the previous night
prior to the faculty review. Daytime responsibilities in general nuclear medicine and PET
increase incrementally over the second year. At this time, the resident is expected to be capable
of making independent judgments on imaging studies, albeit under the watchful eye of a faculty
member.
If their progress and experience is adequate (as assessed by written faculty evaluations and
resident logs), the residents may identify areas of interest for research and begin working on
research project/s with a faculty mentor of their choice during the second year.
The second year is constructed around a more flexible schedule. Second year residents rotate to
the VA Hospital, pediatric nuclear medicine, cardiac nuclear medicine, and nuclear medicine
therapy where they continue to be supervised but at a reduced level. The resident will be given
increasing responsibilities for running each of the services to which they are assigned. They
assume greater responsibility for teaching medical students and radiology residents. There is
more autonomy granted for presentations at intra- and inter-departmental conferences. Their
dictation and communication skills should be improving throughout. At the VA Hospital, the
residents will “pre-dictate” all studies prior to faculty review/editing and signing. If progress is
adequate, residents may elect for additional training in PET, cardiac nuclear medicine, pediatrics
etc.
By the second half of the second year, the resident should be able to contribute substantively to
the daily running of the nuclear medicine service. Preliminary interpretation of studies is
expected, as is increasing facility in the performance of a variety of different procedures;
however, each and every study is reviewed and signed by the assigned faculty member. By the
last 2-3 months of the residency, residents are expected to function independently with minimal
assistance from the supervising faculty member, who nonetheless remains present and available
throughout the day, and who is still required to oversee resident performance.
Description of clinical activities the second year resident may perform
Clinical Activity
Dictate nuclear medicine reports
Perform history and physical examinations
Perform QC on images
Perform appropriateness review
Prescribe diagnostic radiopharmaceutical
doses
Calculate therapy doses
Perform procedures
Supervise stress tests for myocardial
perfusion studies
Obtain informed consent for stress testing
Assume responsibility in nuclear medicine
clinic
Supervisory Level
In-house available supervisory
In-house available supervisory
In-house available supervisory
In-house available supervisory
In-house available supervisory
Direct contact
Direct contact graduating to in-house available
supervisory
In-house available supervisory
In-house available supervisory
In-house available supervisory
Description of teaching activities the second year resident may perform
1.
2.
Supervise clinical care and education of third year medical students
Supervise and teach radiology residents
On –call Supervision of Residents
Residents will be prepared for on-call by didactic and case presentations and their knowledge
and skills tested prior to the rotation. Nuclear Medicine residents will be assigned on-call duties
on a regular basis, during which time the residents will be expected to provide preliminary
interpretations for all studies in the nuclear medicine division during the on-call period. A
faculty member is available to assist and supervise the resident when on-call 24 hours per day,
seven days per week. The faculty member assigned to on-call duties will be continuously
available for consultation by telephone or beeper. Whenever the presence of an on-call faculty
member is requested by the on-call resident or the faculty member recognizes that assistance is
needed (to help with image interpretation or the performance of a procedure), that faculty is
expected to come into the hospital.
3/09/07