EMERGENCY MEDICINE
During the course of the educational program, the resident must acquire and demonstrate satisfactory competence in the knowledge, clinical skills, technical skills, administrative skills and attitudes consistent with the practice of the breadth and depth of emergency medicine, as outlined below.
The purpose of the training is to give the resident a degree of independent responsibility for clinical decisions; an opportunity for further development of the skills required in making effective relationships with patients; the consolidation of competence in primary clinical and technical skills across a broad range of medical practice; and an understanding of the nature of the relationships between a referring physicians and the consulting emergency physician.
This encompasses an understanding of the entire body's anatomy, the physiology of the major organ systems, a thorough understanding of the pathophysiology of
significant illness and injury, principles of pharmacology and toxicology - as well as the natural history of illness and or injuries presenting as emergencies and the principles of the long term and follow up care for these conditions.
This is demonstrated by the competent, independent and primary care of emergencies; including the recognition, evaluation, understanding and initial management of all acute illness and injury particularly of a life threatening nature. The resident will demonstrate the ability to choose investigation and management appropriate to the clinical situation - as well as the selection and timing of other members of the health care team in the immediate and continuing care of his/her patient.
Competence in all surgical and technical procedures commonly performed in Emergency Medicine is expected.
The ability to concomitantly manage a number of ill and injured patients at any given time with a view to both providing these patients with excellence of care as well as ensuring the continued smooth flow of patients through an Emergency Department must be demonstrated. Skills necessary for the effective triage of patients within an Emergency Department are included. Competence in supervisory and administrative aspects of Emergency Medical Services Systems (i.e., the rationalization of Emergency Services, communications systems, prehospital care programs, ambulance services, paramedical emergency services and disaster medicine) is expected.
The ability to communicate effectively with the patient; the demonstration of a compassionate interest in understanding the patient as a person; an appreciation of the psychosocial and family implications of serious illness or injury; the ability to function as a member of the health care team; an understanding of the obligation of continuing self education and the teaching of others; an appreciation of the role of research and the critical analysis of current scientific developments related to the specialty is expected.
Recognition, intervention, resuscitation and stabilization of patient problems presenting to the emergency department.
Relevant anatomy, presentation (symptoms and signs), pathophysiology, natural history, investigative modalities, management and disposition decisions of these acute disorders of body systems encountered in the emergency department.
Evaluation, resuscitation, investigation and stabilization of patients with multiple, and organ specific trauma with respect to mechanisms of injury, pathophysiology, relevant anatomy, presentation, management decisions in the emergency department.
Presentation, normal history of the disease process, psychological factors; investigation, management and disposition decisions of acute disorders in the pediatric and geriatric age group encountered in the emergency department.
General principles of pharmacology, with respect to absorption, kinetics and excretion; the general approach to the poisoned/overdosed patient; the presentations, pathophysiology, history, investigations and management of patients suffering from toxic, overdose and adverse reactions of specific and unknown pharmacological agents and poisons encountered in the emergency department.
The general approach to environmental disorders, the recognition of specific presentations, their pathophysiology, natural history, investigations and the initiation of appropriate management in the emergency department.
Selection, application and interpretation of available investigative modalities in the assessment of patient problems in the emergency department.
Indications, contraindications, prerequisite steps, priority setting in the application of technical skills in the emergency department; preferred and alternate methods; the recognition and assessment of complications of manipulative procedural skills performed in the emergency department.
Organizational and administrative aspects of Emergency Medical Services; prehospital care; disaster planning; quality assurance programs in emergency medicine; medicolegal aspects of emergency medical care; staff education and career development; research.
There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.
The content and organization of each accredited program in diagnostic radiology must be consistent with the specialty training requirements.
Graded responsibility in radiology implies that residents will progress from having all their procedures closely supervised, and all their reports on films checked, to being able to perform procedures with little or no supervision and to report independently. They should, by the end of residency, be skilled in being on call for emergencies, asking for staff advice only when they judge it necessary. Experience in providing consultative services for referring physicians should be well developed at the completion of the residency.
In those cases where a university has sufficient resources to provide most of the training in diagnostic radiology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.
There must be a sufficient number of qualified radiology faculty who are able to provide expertise in all areas of radiology.
The number and variety of patients available to the program on a consistent basis must be sufficient to meet the educational needs of the residents. There must be access to both in and out patient radiology for both adult and pediatric medicine and surgery.
Residents should become experienced in the provision of timely services for outpatients in both hospital and office circumstances. They should acquire experience in the management of patients having radiological procedures in a short stay environment, including pre- and post-procedure care.
An active consultation service is essential to gain experience in primary consultations to referring physicians. Residents must participate in consultations on an ongoing basis throughout their training.
All accredited programs in radiology must provide training in provision of services to referring physicians, including but not limited to: advice on imaging strategies for common clinical presentations, effective utilization of imaging services by referring physicians, and skills in communicating and implementing appropriate guidelines in the context of clinical protocols.
Community experiences should be available and must provide a learning environment with appropriate supervision, patient contacts, and opportunities for evaluation based on rotation specific objectives. There must be administrative support and linkages with the program for these rotations.
There must be appropriate liaison with teaching services in medicine, surgery, pediatrics, obstetrics and gynecology, anesthesia and oncology.
There must be regular exposure of the residents to the radiology of intensive care.
The residents must have experience in providing service for patients from the emergency department, both in and out of regular working hours and under emergency and on-call conditions.
A medical physics program with a formal course of instruction for the radiology residents should be in place. If this is not sufficient for complete instruction, alternative arrangements should be in place with another university to provide this instruction.
There should be close links between anesthesia and radiology in the provision of analgesia and sedation for interventional procedures and for diagnostic procedures. The residents should have exposure to these types of patients in order to acquire the appropriate skills.
There must be a nuclear medicine service, preferably with an accredited residency program in nuclear medicine, with adequate facilities and faculty under the direction of a physician qualified in nuclear medicine. Arrangements must be in place for the instruction and supervision of diagnostic radiology residents in nuclear medicine.
Clinico-pathological correlation is an essential component of the program. Resources must be available to provide this educational experience for the residents.
There must be a designated residents' room or area, a radiology library with an adequate supply of appropriate journals and textbooks and a film and/or an electronic teaching collection. A full medical school library must also be available. Access to computer searches of the literature must be available.
The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.
Both regular resident teaching rounds on case material, and an identifiable program of planned instruction must be in place. The program should include clinical radiology, relevant clinical medicine from various disciplines, medical physics, and pathology.
Residents should be exposed to teachers and experts in all the subspecialty areas of radiology. Usually such faculty will be available from within the program, but disciplines which are not represented locally should be covered by a visiting professor program, and key areas may need to be covered by rotations to other university centres.
The academic program must include teaching in the basic and clinical sciences relevant to the specialty of diagnostic radiology.
The academic program must provide opportunities for the residents to gain an understanding of the basic principles of biomedical ethics as it relates to the specialty of diagnostic radiology including, but not limited to:
There must be opportunities for residents to learn effective communication skills for interacting with patients and their families, colleagues, other allied health professionals, and students.There must be instruction in the principles and practice of effective written and verbal communication of radiology results. Development of consultative skills over the course of the residency should be evident.
Teaching of residents in other programs and of medical students is a useful learning exercise. Teaching of radiography technologists and students, nurses, and referring physicians are skills required of every radiologist, and must be included as part of the residency program.
A documented program of instruction must cover these issues.
Opportunities for research by residents include exposure to research conducted by faculty. There should be a faculty radiology research coordinator. Support for research projects, and assistance and advice should be available for residents interested in research.
Critical appraisal is a mandatory skill and documentation of its acquisition is required. This may be within rounds, as part of a formal academic program, and/or within the context of a journal club program.
A satisfactory level of research and scholarly activity must be maintained among the faculty identified in the program.
The program should provide opportunities for residents to attend conferences outside their own university.
SPECIALTY
REQUIREMENTS:
PROGRAMS (WITH TRAINING REQUIREMENTS):
Eighteen months of approved residency training.
Forty eight months(four years)of approved residency training.