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Welcome to the University of Colorado Denver Neuroradiology
Fellowship!!
Here are a few things you need to know.
- The fellow is essentially responsible for overseeing the daily workings
of the Neuroradiology clinical service, including supervision of the
two residents (one resident in Neuroradiology, one on a neuro-MRI rotation).
The fellow can utilize the resident in assisting with protocols, procedures,
etc. dependant on the resident's skill and knowledge level.
- Procedures. Angiograms, myelograms and biopsies. The fellow is
expected to be involved in all non-angiographic procedures, with
or without a resident. (Generally
in your first few months, without). Know the case ahead of time;
obtain any films, lab results and relevant history. Specifically,
know indications
and contra-indications for procedure. Obtain consent. Be sure a pre-procedure
note is written in the chart including all pertinent. (Angio procedures
are to be performed with the Interventional Radiology Service, with
their guidelines.):
- history, including allergies
- lab values
- relevant physical exam -pulses, pre-existing bruises, hematomas
- neurologic- mental status, etc
Note that Medicare rules require that procedures are discussed
in advance with faculty, faculty are present during procedure, and
case reviewed with faculty prior to formal dictation. AS we sometimes
do not know the insurance status of a patient, we use that procedure
for all cases, unless the faculty deems otherwise for a particular
case. If faculty not present for a procedure (e.g. lumbar puncture,
set the paperwork aside for Staff assistant, and we will be careful
to not place a professional charge for the procedure).
If faculty was present- then state in your dictation, if appropriate,
that case reviewed with faculty before procedure, faculty member
was present during procedure, and the case material, images, etc,
was reviewed with faculty prior to formal dictation at end of procedure.
- Protocols: All protocolling for scheduled MR and CT procedures
should be done the day before, so that the ordering physician can
be contacted with any questions BEFORE the patient arrives in the
department. Check in the am to see if additional cases require protocol.
The residents and fellows should attempt to protocol all studies
first, then consult the attending with any questions.
- Late cases. Please be sure that no urgent or emergent cases are
in progress or pending when you leave the department. If you do
leave, please make sure that a responsible party (on-call or CT-call
resident) will report the results to the ordering physician.
- All ER cases need their results called immediately upon study
completion. We can always call with a revised report when we read
the study. You can tell them that this is a preliminary. Note on
the request who you spoke with and when. Please be sure the residents
do this when checking cases as well. Jot down the impression you
communicated to ordering physician.
- Noon coverage. This will be shared between the fellow and attendings
(residents, too if they don't have conference). Someone must remain
in the department unless cross coverage is arranged.
- Conferences
A. Brain tumor conference: (Tuesday 8:00 -9:00) This is a fellow/faculty
responsibility. The conference is attended by neurosurgery, neuropathology,
neurooncology, neuro-radiation therapy faculty, and fellows. . Residents
are encouraged to review these cases, but this is not their primary
responsibility. Cases are often very complex. As such this is an
excellent fellow-level conference. The fellow is expected to sort
and pre-review
the cases preferably beginning on Monday (use third alternator in
reading room Cases are then reviewed with the attending (typically
the morning of the conference, in-between case reading). Occasionally
these cases require tumor board dictations (by fellow).
B. The fellow is encouraged to attend other subspecialty conferences
These include:
- ENT conference - Monday 7AM
- Neurology Grand Rounds - Wednesdays, 5 PM
- Pituitary conference - Tuesday PM, once a month
- Brain cutting-check with neuropath-the schedule varies -
generally Friday afternoon
C. There are 4-5 GME/AFCGME required lectures on medical ethics,
quality control, etc. Check with Gayle Craun for times/dates-these
are part of resident lecture series and are required. Please be sure
to attend these and sign-in.
D. And of course, we wouldn't want to forget our Thursday
morning conference.
- Moonlighting is permitted, but cannot interfere with your regular
responsibilities. You must obtain pre-approval and complete a standardized
form (see Neuroradiology staff assistant-Bobby Quandt) for forms).
See Housestaff Handbook for additional regulations.
- Performance evaluations: GME requires routine evaluations of performance.
We will evaluate you and vice versa quarterly. Forms are available
and will be provided by Staff Assistant .
a. Quarterly review of fellowship by fellow. Quarterly review of fellow
by faculty.
- Other responsibilities and reading materials as in the resident
responsibilities section. You also will probably want to occasionally
peruse AJNR, which is available in our conference room.
- Fellows are encouraged to become involved with faculty projects.
They are also expected to contribute at least one case a month to
the NeuroWeb teaching file.
- Supervision: All imaging studies are reviewed by a faculty member
at final readout.
- Call: No more than 1 of 3 days or 7 of 21 days on average per
month. All procedures supervised by faculty. Faculty backup
is available at all time. Increasing independence is encouraged,
as you feel more confidant in procedures.
Call and Weekend call--- Discuss procedures with faculty on call.
Habits vary as to time and demands at readout sessions on weekends.
All cases are reviewed daily by both fellow and faculty.
Notify faculty for all procedures. Imaging studies at your discretion.
Call
if unsure or complicated. Residents can perform unassisted, routine
MR and of course CT-studies on call. Residents have the right
to request
assistance-call faculty if you are unsure how to handle any particular
situation.
- Hours: Routine readouts begin at 8-8:15 AM M-F. Cases should be
up on board, and organized before the readouts begin. This is a
resident
responsibility. The Neurosurgeons arrive about 7:50am, M-F for
active case review. Procedures may rarely start before 8am if schedule
is
tight, and of course emergencies can occur anytime. There is no end
of the day, although the residents change shifts at about 4:30-
5pm
if on call. Routine work usually is completed by 5-6 PM; check active
cases before leaving department.
- Duty Hours: We are in compliance with ACGME duty hours requirement.
This is:
Duty hours must be limited to 80 hours per week, averaged over a
four-week period, inclusive of all in-house call activities.
Residents must be provided with 1 day in 7 free from all educational
and clinical responsibilities, averaged over a 4-week period, inclusive
of call. One day is defined as one continuous 24-hour period free
from all clinical, educational, and administrative activities. See
ACGME website for further details.
- Other: Dress codes, etc. as per Housestaff Handbook.
- Here are the requirements for the Neuroradiology
CAQ exam, listing the requirements that you must meet.
Produced by Ed Escott & Jack Simon
Updated April 13, 2004
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