Abdominal Radiology Milestones - The Accreditation Council for Graduate Medical Education - ACGME
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Abdominal Radiology Milestones The Accreditation Council for Graduate Medical Education Implementation Date: July 1, 2022 Second Revision: July 2021 First Revision: February 2014 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. i
Abdominal Radiology Milestones The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGME- accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of the fellow in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context. ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. ii
Abdominal Radiology Milestones Work Group Kamran Ali, MD Sydney McLean, MHA Dennis Balfe, MD Marco Molina, MD Laura Edgar, EdD, CAE Desiree Morgan, MD C. Dan Johnson, MD Anup Shetty, MD David Kim, MD The ACGME would like to thank the following organizations for their continued support in the development of the Milestones: American Board of Radiology ACGME Review Committee for Radiology ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. iii
Understanding Milestone Levels and Reporting This document presents the Milestones, which programs use in a semi-annual review of fellow performance, and then report to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME Competencies organized in a developmental framework. The narrative descriptions are targets for fellow performance throughout their educational program. Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert fellow in the specialty or subspecialty. For each reporting period, the Clinical Competency Committee will review the completed evaluations to select the milestone levels that best describe each learner’s current performance, abilities, and attributes for each subcompetency. These levels do not correspond with post-graduate year of education. Depending on previous experience, a junior fellow may achieve higher levels early in his/her educational program just as a senior fellow may be at a lower level later in his/her educational program. There is no predetermined timing for a fellow to attain any particular level. Fellows may also regress in achievement of their milestones. This may happen for many reasons, such as over scoring in a previous review, a disjointed experience in a particular procedure, or a significant act by the fellow. Selection of a level implies the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page vi). ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. iv
Additional Notes Level 4 is designed as a graduation goal but does not represent a graduation requirement. Making decisions about readiness for graduation and unsupervised practice is the purview of the program director. Furthermore, Milestones 2.0 include revisions and changes that preclude using Milestones as a sole assessment in high-stakes decisions (i.e., determination of eligibility for certification or credentialing). Level 5 is designed to represent an expert fellow whose achievements in a subcompetency are greater than the expectation. Milestones are primarily designed for formative, developmental purposes to support continuous quality improvement for individual learners, education programs, and the specialty. The ACGME and its partners will continue to evaluate and perform research on the Milestones to assess their impact and value. Examples are provided for some milestones within this document. Please note: the examples are not the required element or outcome; they are provided as a way to share the intent of the element. Some milestone descriptions include statements about performing independently. These activities must occur in conformity to ACGME supervision guidelines as described in the Program Requirements, as well as to institutional and program policies. For example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight. A Supplemental Guide is also available to provide the intent of each subcompetency, examples for each level, assessment methods or tools, and other available resources. The Supplemental Guide, like examples contained within the Milestones, is designed only to assist the program director and Clinical Competency Committee, and is not meant to demonstrate any required element or outcome. Additional resources are available in the Milestones section of the ACGME website. Follow the links under “What We Do” at www.acgme.org. ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. v
The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be indicated by selecting the level of milestones that best describes that fellow’s performance in relation to those milestones. Selecting a response box in the Selecting a response box on the line in middle of a level implies that between levels indicates that milestones milestones in that level and in lower in lower levels have been substantially levels have been substantially demonstrated as well as some demonstrated. milestones in the higher level(s). ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. vi
Version 2 Abdominal Radiology, ACGME Report Worksheet Patient Care 1: Consultant Level 1 Level 2 Level 3 Level 4 Level 5 For routine radiology For complex radiology Manages radiology Provides Participates in research, consultations, delineates consultations, delineates consultations comprehensive development, and the clinical question, the clinical question, independently, taking into radiology consultations implementation of obtains appropriate obtains appropriate consideration cost at the expected level of abdominal imaging clinical information, uses clinical information, uses effectiveness and risk an abdominal guidelines evidence-based imaging evidence-based imaging benefit analysis radiologist guidelines, and guidelines, and recommends next steps recommends next steps with assistance with assistance Comments: Not Yet Completed Level 1 Not Yet Assessable ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 1
Version 2 Abdominal Radiology, ACGME Report Worksheet Patient Care 2: Competence in Procedures Level 1 Level 2 Level 3 Level 4 Level 5 Performs simple Competently performs Proficiently performs Proficiently and Participates in research or procedures, with direct simple procedures, with simple and complex independently performs innovation involving supervision indirect supervision and procedures, with indirect simple and complex abdominal imaging complex procedures, with supervision procedures procedures direct supervision Recognizes Manages complications of Anticipates and Proficiently and Participates in research complications of procedures, with independently manages independently manages on innovative methods procedures and enlists supervision complications of complications of designed to reduce help procedures procedures procedural complications Mentors learners on the Instructs learners on Instructs learners on Develops educational indications for procedures performing simple performing simple and materials for learners and management of procedures and managing complex procedures regarding procedures complications complications and managing complications Comments: Not Yet Completed Level 1 Not Yet Assessable ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 2
Version 2 Abdominal Radiology, ACGME Report Worksheet Patient Care 3: Image Interpretation Level 1 Level 2 Level 3 Level 4 Level 5 Identifies primary, Prioritizes differential Provides a single Demonstrates expertise Integrates state-of-the-art secondary, and critical diagnoses and diagnosis with integration in diagnosis at a level research and literature imaging findings and recommends of current guidelines to expected of an into image interpretation formulates differential management options recommend management, abdominal radiologist diagnoses when appropriate Comments: Not Yet Completed Level 1 Not Yet Assessable ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 3
Version 2 Abdominal Radiology, ACGME Report Worksheet Medical Knowledge 1: Imaging Technology and Physics Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Demonstrates knowledge Proficiently optimizes Demonstrates expertise Presents or publishes knowledge of basic of instrument quality image acquisition and in image acquisition and research on imaging image acquisition and control and image processing in processing optimization, technology image processing, and reconstruction and collaboration with the and provides instruction recognizes common troubleshoots for artifact technology/imaging team to trainees and imaging imaging artifacts and reduction team technical problems Applies knowledge of Demonstrates knowledge Applies physical principles Teaches principles of basic medical physics of more advanced to optimize dose reduction physics and dose and radiobiology to medical physics and in abdominal imaging optimization to learners abdominal imaging radiobiology to abdominal imaging Comments: Not Yet Completed Level 1 Not Yet Assessable ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 4
Version 2 Abdominal Radiology, ACGME Report Worksheet Medical Knowledge 2: Protocol Selection and Contrast Agent Selection/Dosing Level 1 Level 2 Level 3 Level 4 Level 5 Discusses the protocols Selects appropriate Selects appropriate Modifies protocols and Develops and implements and contrast agent/dose protocols and contrast protocols and contrast contrast agent/dose as imaging protocols for abdominal imaging agent/dose for routine agent/dose for complex determined by clinical abdominal imaging abdominal imaging circumstances Comments: Not Yet Completed Level 1 Not Yet Assessable ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 5
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 1: Patient Safety Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Identifies system factors Participates in analysis of Conducts analysis of Actively engages teams knowledge of common that lead to patient safety patient safety events patient safety events and processes to modify patient safety events events (simulated or actual) and offers error systems to prevent prevention strategies patient safety events (simulated or actual) Demonstrates Reports patient safety Participates in disclosure Discloses patient safety Role models or mentors knowledge of how to events through of patient safety events to events to patients and others in the disclosure of report patient safety institutional reporting patients and families families (simulated or patient safety events events systems (simulated or (simulated or actual) actual) actual) Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 6
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 2: Quality Improvement Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Describes local quality Participates in local Demonstrates the skills Creates, implements, and knowledge of basic improvement initiatives quality improvement required to identify, assesses quality quality improvement initiatives develop, implement, improvement initiatives at methodologies and and analyze a quality the institutional or metrics improvement project community level Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 7
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 3: System Navigation for Patient-Centered Care Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Coordinates care of Coordinates care of Role models effective Analyzes the process of knowledge of care patients in routine patients in complex coordination of patient- care coordination and coordination in radiology radiology radiology centered care among leads in the design and imaging/procedures imaging/procedures imaging/procedures different disciplines and implementation of effectively using the roles effectively using the roles specialties improvements of interprofessional teams of interprofessional teams Identifies key elements Performs safe and Performs safe and Role models safe and Improves quality of for safe and effective effective transitions of effective transitions of effective transitions of transitions of care to transitions of care and care/hand-offs in routine care/hand-offs in complex care/hand-offs optimize patient outcomes hand-offs clinical situations clinical situations Demonstrates Identifies specific Identifies local resources Participates in adapting Leads innovations and knowledge of population population and available to meet the the practice to provide advocates for populations and community health community health needs needs of a patient for the needs of specific and communities with needs and disparities and inequities for their population and populations (actual or health care inequities local population community simulated) Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 8
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 4: Physician Role in Health Care Systems Level 1 Level 2 Level 3 Level 4 Level 5 Identifies key Describes how Discusses how individual Manages various Advocates for or leads components of the components of a complex practice affects the components of the systems change that complex healthcare health care system are broader system (e.g., complex health care enhances high-value, system (e.g., hospital, interrelated, and how this length of stay, system to provide efficient, and effective finance, personnel, impacts patient care readmission rates, clinical efficient and effective patient care and transition technology) efficiency) patient care and of care transition of care Describes the States relative cost of Describes the technical Describes the radiology Participates in health mechanisms for common abdominal and professional revenue cycle and policy advocacy activities reimbursement, including radiology procedures components of imaging measurements of types of payors costs productivity (e.g., relative value units) Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 9
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 5: Contrast Agent Safety Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Recognizes contrast Manages contrast Independently manages Leads educational knowledge of contrast reactions (simulated or reactions, with contrast reactions experience in simulation reactions, and efficiently actual), and identifies supervision (simulated or (simulated or actual) laboratory for contrast accesses critical specific patient-based actual) reaction resources for management issues management Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 10
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 6: Radiation Safety Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Accesses resources to Communicates the Applies principles of Creates, implements, and knowledge of the determine exam-specific relative risk of exam- ALARA in daily practice, assesses radiation safety mechanisms of radiation average radiation dose specific radiation including methods of initiatives at the injury and the ALARA information exposure to patients and dose reduction and institutional level (“as low as reasonably practitioners image optimization in achievable”) concept fluoroscopy and computerized tomography (CT) Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 11
Version 2 Abdominal Radiology, ACGME Report Worksheet Systems-Based Practice 7: Magnetic Resonance (MR) Safety Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Accesses resources to Communicates MR Applies principles of MR Creates, implements, and knowledge of the risks of determine the safety of safety, including implants safety to daily practice assesses MR safety magnetic resonance implanted devices and and retained foreign initiatives at the imaging (MRI), including retained foreign bodies bodies, to patients and institutional level safety zones and pre-MR practitioners screening Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 12
Version 2 Abdominal Radiology, ACGME Report Worksheet Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates how to Articulates clinical Locates and applies the Critically appraises Coaches others to access and use available questions and elicits best available evidence, conflicting evidence to critically appraise and evidence to determine patient preferences and integrated with patient guide care, tailored to apply evidence for the best imaging values in order to guide preferences and values, the individual patient complex patients; and/or examination for a routine evidence-based imaging to the care of complex participates in the patient/diagnosis patients development of guidelines Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 13
Version 2 Abdominal Radiology, ACGME Report Worksheet Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Professional Growth Level 1 Level 2 Level 3 Level 4 Level 5 Accepts responsibility for Receptive to performance Episodically seeks Consistently seeks Coaches other learners to professional data and feedback in performance data and performance data and consistently seek development by order to adjust goals feedback, with humility feedback with humility performance data and establishing goals and adaptability and adaptability feedback Identifies factors which Analyzes and reflects on Analyzes, reflects on, and Analyzes effectiveness Coaches others on contribute to gap(s) factors which contribute to institutes behavioral of behavioral changes reflective practice between expectations gap(s) between change(s) to narrow the where appropriate and and actual performance expectations and actual gap(s) between considers alternatives in performance expectations and actual narrowing the gap(s) performance between expectations and actual performance Actively seeks Designs and implements Designs and implements Uses performance data Facilitates the design and opportunities to improve a learning plan, with a learning plan to measure the implements learning plans performance prompting independently effectiveness of the for others learning plan and when necessary, improves it Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 14
Version 2 Abdominal Radiology, ACGME Report Worksheet Professionalism 1: Professional Behavior and Ethical Principles Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Demonstrates insight into Demonstrates Recognizes situations Coaches others when knowledge of professional behavior in professional behavior in that may trigger their behavior fails to expectations for routine situations and complex or stressful professionalism lapses meet professional professional behavior takes responsibility for situations and intervenes to expectations and describes how to own professionalism prevent lapses in self appropriately report lapses and others professional lapses Demonstrates Analyzes straightforward Recognizes need to seek Recognizes and uses Identifies and seeks to knowledge of the ethical situations using ethical help in managing and appropriate resources address system-level principles underlying principles resolving complex ethical for managing and factors that induce or informed consent, situations resolving ethical exacerbate ethical surrogate decision dilemmas as needed problems or impede their making, advance (e.g., ethics resolution directives, confidentiality, consultations, literature error disclosure, and review, risk stewardship of limited management/legal resources consultation) Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 15
Version 2 Abdominal Radiology, ACGME Report Worksheet Professionalism 2: Accountability/Conscientiousness Level 1 Level 2 Level 3 Level 4 Level 5 Responds promptly to Performs tasks and Performs tasks and Recognizes and raises Takes ownership of requests or reminders to responsibilities in a timely responsibilities in a timely awareness of situations system outcomes complete tasks and manner to ensure that the manner to ensure that the that may impact others’ responsibilities needs of patients, teams, needs of patients, teams, ability to complete tasks and systems are met in and systems are met in and responsibilities in a routine situations complex or stressful timely manner situations Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 16
Version 2 Abdominal Radiology, ACGME Report Worksheet Professionalism 3: Self-Awareness and Help-Seeking Level 1 Level 2 Level 3 Level 4 Level 5 Recognizes status of Independently recognizes With assistance, Independently develops Coaches others when personal and status of personal and proposes a plan to a plan to optimize emotional responses or professional well-being, professional well-being optimize personal and personal and limitations in with assistance, and is using available resources professional well-being professional well-being knowledge/skills do not aware of available when appropriate meet professional resources expectations Recognizes limits in the Independently recognizes With assistance, Independently develops knowledge/skills of self limits in the proposes a plan to a plan to remediate or or team, with assistance knowledge/skills of self or remediate or improve improve limits in the team and demonstrates limits in the knowledge/ knowledge/skills of self appropriate help-seeking skills of self or team or team behaviors Comments: Not Yet Completed Level 1 This subcompetency is not intended to evaluate a fellow’s well-being, but to ensure each fellow has the fundamental knowledge of factors that impact well- being, the mechanisms by which those factors impact well-being, and available resources and tools to improve well-being. ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 17
Version 2 Abdominal Radiology, ACGME Report Worksheet Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication Level 1 Level 2 Level 3 Level 4 Level 5 Accurately Identifies barriers to Identifies biases that Actively minimizes Coaches other learners to communicates own role effective communication hinder effective communication barriers minimize communication within the health care (e.g., language, health communication barriers system literacy, cultural) Identifies the need to Organizes and initiates With guidance, sensitively Independently, uses Coaches other learners in adjust communication communication with and compassionately shared decision making shared decision making strategies based on patient/family by clarifying delivers medical to align patient goals, assessment of expectations and verifying information, elicits patient and preferences with patient/family understanding of the goals and preferences, treatment options to expectations and clinical situation and acknowledges make a personalized understanding of their uncertainty and conflict care plan health status and treatment options Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 18
Version 2 Abdominal Radiology, ACGME Report Worksheet Interpersonal and Communication Skills 2: Interprofessional and Team Communication Level 1 Level 2 Level 3 Level 4 Level 5 Clearly and concisely Checks understanding of Coordinates Role models flexible Coaches other learners in responds to a recommendations when recommendations from communication tailored communications consultation request providing consultation different members of the strategies that value to referring providers health care team to input from all health optimize patient care care team members, resolving conflict when needed Communicates emergent Communicates non- Communicates findings findings according to emergent findings where and management options institutional or national failure to act may (as appropriate) which are guidelines adversely affect patient tailored to the referring outcome provider Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 19
Version 2 Abdominal Radiology, ACGME Report Worksheet Interpersonal and Communication Skills 3: Communication within Health Care Systems Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Communicates systems Communicates clear and Facilitates dialogue Teaches and/or conducts knowledge of institutional concerns in a respectful constructive suggestions regarding systems research related to communications policies manner to improve systems issues among larger system and process and systems community stakeholders improvement (institution, health care system, field) Comments: Not Yet Completed Level 1 ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Abdominal Radiology Milestones on a non-exclusive basis for educational purposes. 20
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