Goals and Objectives: Therapeutic Nuclear Medicine (1 Year Curriculum-Nuclear Residency Program) Description of Rotation or Educational Experience The one year curriculum emphasizes nuclear medicine therapy training because the graduate of radiology residency has only had very basic exposure to this rotation. The goal is to provide the fundamentals of therapy with unsealed radioactive sources, including the general principles, patient selection and familiarity with dosage calculation. There is hands-on experience in the therapy clinic with patient examination and dose administration, supplemented by lectures in radiobiology. With additional therapy rotations, there will be increased familiarity with nuclear medicine therapy. Residents are expected to function with a reduced level of supervision in examining patients, selecting patients for therapy, calculating dosages and providing radiation protection instructions. 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. Perform a good history and physical examinations with patients who are being considered for radiopharmaceutical therapy. 2. Learn to effectively obtain information from medical record and clinical physicians. 3. Learn how elicit symptoms and signs for follow up of patients who have received therapeutic radiopharmaceuticals. After the introductory period, residents are expected to: 1. In addition to all the above, become more sophisticated in the evaluation and treatment of patients who are being considered for, or have received radiopharmaceutical therapy. 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 evaluation and management of therapy patients. 5. By the end of the rotations in therapy, the resident must have been involved in the treatment of radioiodine in hyperthyroidism (minimum of 10 cases), radioiodine in thyroid cancer (minimum of 5 cases), radiolabeled antibodies (minimum of 3 cases) and radionuclides for painful bone disease (minimum of 3 cases), including follow-up of the same number of cases. Medical Knowledge Goal 1 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 three months, residents are expected to: 1. Understand the concepts of nuclear medicine physics and radiobiology, as they relate to nuclear medicine therapy. 2. Begin to recognize the symptoms and signs of diseases treated by unsealed sources of radioactivity e.g. Graves’ disease. 3. Understand basic concepts of appropriate patient selection and calculation of the administered doses. 4. Learn basic concepts of radiation protection. 5. Understand methods to follow up patients who have been treated.. After the introductory period, residents are expected to: 1. Be proficient in the concepts of nuclear medicine physics and radiobiology, as they relate to nuclear medicine therapy. 2. Learn the symptoms and signs of diseases treated by unsealed sources of radioactivity. 3. Understand appropriate patient selection, treatment algorithms and dosage calculations for hyperthyroidism, thyroid cancer, painful metastases, lowgrade lymphoma, etc. 4. Learn the concepts of radiation protection and be proficient in instructing patients and family members. 5. Learn methods to follow up patients who have been treated, as well as deal with complications of therapy. 6. Acquire increasingly sophisticated knowledge and demonstrate facility with independently running a therapy clinic (with reduced level of supervision). 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 on therapeutic nuclear medicine. 2. Present and contribute to discussion of therapy patients at Tumor Boards. 3. Participate in annual self-assessment exercise, identify strengths and limitations and develop own learning goals. Systems Based Practice Goal 2 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. Gain basic knowledge of the role of nuclear medicine therapy in the treatment of patients with hyperthyroidism, thyroid cancer, painful bone metastases and lymphoma. 2. Fully understand the relative merits of the different nuclear medicine therapy techniques and able to make recommendations to the clinical service concerning the best treatment modalities for an individual case. 3. Demonstrate basic knowledge about the costs of therapy studies. 4. Be aware of the roles of the regulatory agencies such as the Nuclear Regulatory Commission (NRC). 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 therapy patients, demonstrating great sensitivity toward their patient’s 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 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. Demonstrate sensitivity to the needs of the diverse patient population, including but not limited to cancer patients. 6. Not discriminate based on age, ethnicity, gender, disability or sexual orientation. 7. Act professionally with a responsible work ethic and respect for all members of the team by directing all aspects of the therapeutic procedures efficiently and smoothly. 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. 3 Objectives Residents are expected to (to be): 1. Gain mastery of dictation of clinical and therapy reports using clear and concise language. Over the year of training, the resident will be expected to compose the report with progressively less assistance. 2. Able to verbally communicate about nuclear medicine therapy procedures concisely and clearly to referring physicians. 3. Develop an ability to calmly and clearly educate patients concerning nuclear medicine therapy and radiation protection. Demonstrate appropriate patience and empathy in this communication. 4. Demonstrate appropriate communication skills with technologists on the therapy service with whom they interact. Teaching Methods Formal, didactic lectures on therapy Small group teaching on individual cases Conferences and Tumor Boards Teaching files on service, teaching files on internet Written material in textbooks; scientific articles provided by faculty 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)for documentation of cases 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 Supervision in the therapy clinic is direct throughout the rotation. Residents take on greater responsibility including history and physicals and presentation of cases. Responsibility increases throughout, but all patients, dose calculations and dictated reports are reviewed by the faculty. Educational Resources Textbooks in the Fellow Library Taubman Medical Library Electronic Teaching File 4 Access to Internet, Medline Search and PubMed 3/09/07 5