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Fellow Goals

Welcome to the University of Colorado Health Sciences Center Neuroradiology Fellowship!!
Here are a few things you need to know.

  1. 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.
  1. Procedures. Angiograms, myelograms and biopsies. The fellow is expected to be involved in all, 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:
  • 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  1. Conferences

    A.  Brain tumor conference: (Tuesday 1:30-2:30) 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).


    2. B.  The fellow is encouraged to attend other subspecialty conferences  These include:

      - ENT conference  - Monday 7AM
      - Neurology Grand Rounds - Wednesdays, 5 PM
      - Pituitary conference - Wednesday AM, 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.
     

  2. 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.

    3.  
  3. 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 .

    4. a. Quarterly review of fellowship by fellow. Quarterly review of fellow by faculty.
    b. Take the Imaging examination on Neuroradiology web at the start of your fellowship and again at twelve months. Set a high standard for the residents to shoot for.
     
  4. 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.

    5.  
  5. 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.

    6.  
  6. Supervision: All imaging studies are reviewed by a faculty member at final readout.

    7.  
  7. 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.


    8. 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 fellow or faculty or both. 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.
     

  8. 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 8:15-830, 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.

    9.  
  9. Other: Dress codes, etc. as per Housestaff Handbook.

    10.  
  10. Here are the requirements for the Neuroradiology CAQ exam, listing the requirements that you must meet.
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Produced by Ed Escott & Jack Simon

Updated April 26, 1999