The Endovascular Surgical Neuroradiology Milestone Project › Portals › 0 › PDFs › Milestones › ...based on location and imaging features using various diagnostic imaging

The Endovascular Surgical Neuroradiology

Milestone Project

A Joint Initiative of The Accreditation Council for Graduate Medical Education

The American Board of Neurological Surgery

The American Board of Psychiatry and Neurology

The American Board of Radiology

July 2015

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The Endovascular Surgical Neuroradiology Milestone Project

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 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.

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Endovascular Surgical Neuroradiology Milestones

Chair: B. Greg Thompson, MD

Working Group Advisory Group

Colin Derdeyn, MD Hunt Batjer, MD

Pam Derstine, PhD, MHPE Gary Becker, MD

Laura Edgar, EdD, CAE Lawrence Davis, MD

Muhammad Hussain, MD Larry Faulkner, MD

Alexander Khalessi, MD, MS Steven Lewis, MD

Lawrence Wechsler, MD Mary Lieh-Lai, MD

Robert Zimmerman, MD Louis Ling, MD

John Potts, MD

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Milestone Reporting

This document presents milestones designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship through graduation. In the initial years of implementation, the Review Committee will examine Milestone performance data for each program’s fellows as one element in the Next Accreditation System (NAS) to determine whether fellows overall are progressing. For each period, review and reporting will involve selecting Milestone levels that best describe a fellow’s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert in the subspecialty. Selection of a level implies that the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v).

Level 1: The fellow demonstrates milestones expected of an incoming fellow.

Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level.

Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for fellowship.

Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is designed as the graduation target.

Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional fellows will reach this level.

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Additional Notes

Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for

graduation is the purview of the fellowship program director. Study of Milestone performance data will be required before the

ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the

developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions.

Examples are provided with some milestones. Please note that 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 the ACGME supervision guidelines, 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.

Answers to Frequently Asked Questions about Milestones are available on the Milestones web page: http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.

http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf

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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 that best describes that fellow’s performance in relation to those milestones.

Selecting a response box in the middle of a

level implies that milestones in that level and

in lower levels have been substantially

demonstrated.

Selecting a response box on the line in between levels

indicates that milestones in lower levels have been

substantially demonstrated as well as some milestones

in the higher level(s).

04/2014 Endovascular Surgical Neuroradiology Milestones, ACGME Report Worksheet

Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Neurological Surgery, The American Board of Psychiatry and Neurology, and The American Board of Radiology. All rights reserved. The copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes. 1

MK1: Intracranial Aneurysm Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates basic understanding of cerebral vascular anatomy and physiology Demonstrates understanding of clinical presentation/course of ruptured cerebral aneurysms Describes natural history of unruptured cerebral aneurysms Recognizes and appropriately classifies cerebral aneurysms based on location and imaging features using various diagnostic imaging modalities Appropriately classifies subarachnoid patients using established grading scales (e.g., Hunt and Hess, Fisher)

Demonstrates understanding of variant cerebral vascular anatomy and pathophysiology Lists indications, risks, benefits, contraindications, and alternatives of treatment (including no treatment) for intracranial aneurysm Recognizes and discusses complications of subarachnoid hemorrhage (e.g., hyponatremia, delayed neurological deficit, hydrocephalus, seizures) Demonstrates knowledge of risk factors for peri-procedural complications

Familiar with seminal literature and evidence-based guidelines regarding medical, surgical, and endovascular options for intracranial aneurysm Recognizes features on imaging to determine optimal method of endovascular treatment (e.g., use of adjuncts such as stent or balloon) Recognizes clinical and imaging features to determine optimal treatment modality (observation, endovascular, microsurgical) Demonstrates knowledge of medical management adjuncts Demonstrates knowledge of intensive care for subarachnoid hemorrhage patients

Describes expected outcomes following endovascular therapy Describes the indications for medical, endovascular, and microsurgical treatment of intracranial aneurysms Describes the indications for endovascular treatment of subarachnoid hemorrhage induced vasospasm Demonstrates a comprehensive understanding of available endovascular technologies for aneurysm treatment

Discusses advanced combined treatment for complex aneurysm (e.g., bypass) Contributes to the peer-reviewed literature regarding cerebral aneurysmal disease and subarachnoid hemorrhage

Comments:

Not yet achieved Level 1



PC1: Intracranial Aneurysm Level 1 Level 2 Level 3 Level 4 Level 5 Performs a history and neurological examination in patients with cerebral aneurysm and/or subarachnoid hemorrhage Safely and effectively performs a diagnostic cerebral angiogram with supervision Initiates the appropriate imaging evaluation of patients presenting with subarachnoid hemorrhage Performs basic elements of intracranial endovascular procedures with assistance

Effectively evaluates and establishes a treatment plan for patients with unruptured aneurysm in a supervised outpatient setting Recognizes complications of subarachnoid hemorrhage Recognizes complications of endovascular aneurysm treatment Appropriately utilizes antiplatelets and antithrombotics in the peri-procedural period Manages vascular closure with devices, and manages complications of vascular access Performs basic elements of intracranial endovascular procedures with supervision Performs complex elements of endovascular aneurysm procedures with assistance

Initiates appropriate management of complications of subarachnoid hemorrhage Initiates appropriate management of complications of endovascular aneurysm treatment Performs basic elements of intracranial endovascular procedures independently Performs complex elements of endovascular aneurysm procedures with supervision

Performs complex elements of endovascular aneurysm procedures independently Appropriately coordinates care for patients with aneurysmal subarachnoid hemorrhage Establishes and executes plan for outpatient follow-up of treated and untreated patients

Uses patient quality data to improve patient outcomes Leads multidisciplinary team in the management of complex aneurysmal disease

Comments:




MK2: Vascular Malformation

Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates basic understanding of cerebral and spinal vascular anatomy and physiology Demonstrates understanding of clinical presentation/course of ruptured vascular malformations Describes natural history of unruptured cerebral and spinal vascular malformations Recognizes and appropriately diagnoses cerebral and spinal vascular malformations based on imaging features using various diagnostic imaging modalities Appropriately classifies cerebral and spinal vascular malformations using established grading scales (e.g., Spetzler-Martin for AVM, Borden, Cognard for dural fistulas)

Demonstrates understanding of pathophysiology of cerebral and spinal vascular malformations, including perfusion pressure breakthrough Lists indications, risks, benefits, contraindications, and alternatives of treatment for cerebral and spinal vascular malformations (observation, endovascular, microsurgical, radiosurgery, and combined) Demonstrates knowledge of risk factors for peri-procedural complications

Familiar with seminal literature and evidence-based guidelines regarding medical, surgical, and endovascular options for cerebral and spinal vascular malformation Recognizes clinical and imaging features to determine optimal treatment modality (observation, endovascular, microsurgical, radiosurgery and combined) Recognizes features on imaging to determine optimal method of endovascular treatment (i.e., use of adjuncts)

Describes expected outcomes following endovascular therapy Describes the indications for medical, endovascular, microsurgical, radiosurgical, and combined treatment of cerebral and spinal vascular malformations Demonstrates a comprehensive understanding of available endovascular technologies for cerebral and spinal vascular malformation treatment

Contributes to the peer-reviewed literature on cerebral vascular malformations

Comments:




PC2: Vascular malformations Level 1 Level 2 Level 3 Level 4 Level 5 Performs a history and neurological examination in patients with cerebral and spinal vascular malformations Safely and effectively performs diagnostic cerebral and spinal cerebral angiography with supervision Initiates the appropriate evaluation of patients presenting with ruptured cranial and spinal vascular malformations Performs basic elements of intracranial endovascular and intraspinal procedures with assistance

Effectively evaluates and establishes a treatment plan for patients with unruptured cerebral and spinal vascular malformations in a supervised outpatient setting Recognizes complications of unruptured cerebral and spinal vascular malformations Recognizes complications of endovascular vascular malformation treatment Appropriately utilizes antithrombotics in the peri-procedural period Manages vascular closure with devices, and manages complications of vascular access Performs basic elements of intracranial and spinal endovascular procedures with supervision Performs complex elements of endovascular procedures with assistance

Initiates appropriate management of complications of endovascular vascular malformation treatment Performs basic elements of intracranial and spinal endovascular procedures independently Performs complex elements of endovascular cranial and spinal procedures with supervision

Performs complex elements of intracranial and spinal endovascular procedures independently Appropriately coordinates care for patients with ruptured cerebral vascular malformations Establishes and implements a plan for outpatient follow-up of treated and untreated patients

Uses patient quality data to improve patient outcomes Leads multidisciplinary team in the management of cerebral and spinal vascular malformations

Comments: Not yet achieved Level 1



MK3: Arterial Occlusive Disease (AOD) Level 1 Level 2 Level 3 Level 4 Level 5 Understands pathogenesis of arterial occlusive disease, including Moya Moya, atherosclerosis, and dissection Understands symptoms of stroke and transient ischemic attack (TIA) Demonstrates knowledge of imaging features of different vascular modalities and selection of appropriate imaging based on clinical situation Understands patterns of vascular collateralization

Understands medical treatment options based on AOD etiology Demonstrates knowledge of clinical syndromes associated with compromise of anatomic vascular distributions Understands the acquisition and utility of perfusion and other advanced imaging methods Identifies key clinical collaterals in AOD

Familiar with seminal literature and evidence-based guidelines regarding medical, surgical, and endovascular options for carotid disease and Internal Carotid Artery Dissection Demonstrates knowledge of treatment options for AOD based on anatomic location, including risk and benefit profiles Recognizes imaging findings associated with common AOD pathology, including Moya Moya, atherosclerosis, and dissection Understands physiologic responses to drive perfusion

Integrates clinical findings, imaging results, and pattern of collateralization to inform a plan of care Understands the range of procedure-related complications, their signs, symptoms, and management Demonstrates knowledge of long-term outcomes and need for surveillance imaging in AOD

Publishes in the peer-reviewed literature on AOD Participates in the development of new devices for treatment of AOD, including participation in clinical trials Participates as a faculty member in the training of other physicians and learners in the management of AOD

Comments:




PC3: Arterial Occlusive Disease (AOD) Level 1 Level 2 Level 3 Level 4 Level 5 Diagnoses and provides appropriate medical management for extracranial carotid disease Familiar with intensive medical therapy regimen (e.g., SAMMPRIS), and diagnoses intracranial atherosclerotic disease Applies diagnostic classification (e.g., Denver) to inform the management of carotid dissection Obtains relevant history, labs, and medications required for endovascular procedures Safely and effectively performs a diagnostic cerebral angiogram with supervision

Completes appropriate clinical and imaging work-up to identify patients benefiting from carotid endarterectomy (CEA) or carotid artery stenting (CAS) Understands clinical and imaging factors that guide potential endovascular intervention or extracranial to intracranial (EC-IC) bypass Performs diagnostic angiogram and macrovascular access for carotid dissection procedure Manages medical complications of contrast nephropathy, embolic stroke, aspiration, and unstable arrhythmias

Successfully performs diagnostic cerebral angiogram, macrovascular guide access for CAS procedure and post-procedure care Performs uncomplicated intracranial angioplasty and stenting for intracranial atherosclerotic disease (ICAD) Obtains complex macrovascular guide access (e.g., Type III arch, brachial/radial approach) Provides peri-procedural blood pressure management in endovascular procedures (e.g., glycopyrrolate in CAS)

Successfully performs standard CAS procedure with distal embolic protection devices (DEPD) or balloon angioplasty Recognizes and manages of common intra-procedural complications Performs complicated intracranial angioplasty and stenting involving tandem lesions Manages iatrogenic complications, including vessel dissection or extravasation Manage all phases of peri-procedural sedation, including monitored anesthesia care (MAC) and conscious sedation

Leads a root-cause analysis for endovascular complications

Comments:




MK4: Acute Ischemic Stroke (AIS) Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates knowledge of signs and symptoms of AIS Demonstrates knowledge of the varying etiologies of stroke (e.g., structural vascular disease, cardioembolic) Demonstrates knowledge of inclusion and exclusion criteria for intravenous tissue plasminogen activator (iv-tPA) administration Demonstrates knowledge of imaging characteristics of acute infarction

Understands the anatomic substrate that corresponds with the clinical syndrome Understands the medical therapies available for secondary prevention of stroke based on etiology Demonstrates knowledge of the indications for endovascular treatment Demonstrates knowledge of the progression of imaging findings in stroke over time

Demonstrates knowledge of the clinical trial data regarding revascularization rate and clinical outcomes associated with iv-tPA vs. endovascular therapy for candidate occlusion Demonstrates knowledge of clinical and imaging features, such as ASPECT score, location, patient age, and clot type, that impact clinical and technical success Demonstrates understanding of a range of mechanical thrombectomy devices and dosing of intra-arterial pharmacologic agents for endovascular therapy Recognizes the imaging features of post-stroke treatment, including contrast staining

Understands range of medical and procedural complications associated with endovascular treatment of AIS, including identification of symptomatic intracranial hemorrhage (ICH), device-induced vasospasm, vessel dissection, and persistent occlusion Understands secondary mechanisms of injury including loss of blood-brain barrier, reperfusion injury, oxidative stress, and inflammation Understands strategic and treatment implications of tandem occlusions

Contributes to the literature regarding clinical features and management of AIS Participates in teaching and training of residents in fellows concerning the management of acute stroke Contributes to the advancement of technology for the treatment of AIS

Comments:




PC4: Acute Ischemic Stroke (AIS) Level 1 Level 2 Level 3 Level 4 Level 5 Performs simple diagnostic cerebral angiogram Performs complete neurological exam, including NIHSS assessment Performs complete history to establish last known normal, medication history and contraindications Interprets parenchymal and vascular imaging to determine diagnosis and guide treatment decisions Identifies and coordinates stabilization of patients in extremitus (e.g., respiratory failure, acute hydrocephalus)

Performs ongoing patient assessment and manages possible complications of iv-tPA administration or cerebral edema (e.g., need for decompressive craniectomy) Determines whether stroke patient is candidate for endovascular intervention based on clinical and imaging criteria Performs complex diagnostic cerebral angiogram (e.g., Type III arch or tandem lesion) Manages intra-procedural sedation, hemodynamics, and rheology in simple cases

Performs mechanical thrombectomy procedure in uncomplicated cases (i.e., simple anterior circulation) Manages common complications (e.g., groin hematoma, catheter-induced spasm) Coordinates post-procedural care, including blood pressure control, neurovascular checks, and interpretation of surveillance imaging Understands and applies indications for cerebral spinal fluid diversion or decompressive craniectomy

Demonstrates proficiency in a range of mechanical thrombectomy devices and techniques, including aspiration system and stentrievers Manages rare, serious complications (e.g., vessel dissection, perforation, or extravasation) Performs complex stroke intervention, such as tandem carotid stenting with mechanical thrombectomy or posterior circulation occlusion

Leads an interdisciplinary stroke team at a comprehensive stroke center (CSC) Contributes to peer-reviewed literature in AIS Serves as a faculty member for endovascular education Participates in the development of new thrombectomy devices

Comments:




MK5: Vascular Imaging (e.g., computed tomography [CT], magnetic resonance [MR], angiography, ultrasonography) Level 1 Level 2 Level 3 Level 4 Level 5 Differentiates normal from abnormal findings and identifies potential significance Makes core observations, formulates differential diagnoses, and recognizes critical findings Recognizes need to modify imaging protocols based on patient comorbidities

Uses imaging findings in operative planning for basic procedures Makes secondary observations and prioritizes differential diagnoses Modifies imaging protocol to optimize data acquisition With supervision, generates an accurate, concise, and organized report of imaging findings

Independently generates an accurate, concise, and organized report of imaging findings Uses imaging findings in operative planning for intermediate procedures Differentiates modalities based on comparative effectiveness and cost Describes appropriate contrast dosing (e.g., for pediatric patients, renal disease)

Independently uses multidimensional imaging (e.g., 3-D computed tomography angiography [CTA]) Uses imaging findings in operative planning for advanced procedures Observes and interprets subtle findings

Implements innovative imaging technology to enhance the care of the patient Teaches imaging interpretation to other learners

Comments:




PC5: Vascular Imaging Level 1 Level 2 Level 3 Level 4 Level 5 Recognizes and manages contrast reactions Describes the mechanisms of radiation injury and the ALARA (“as low as reasonably achievable”) concept Accesses resources to determine exam-specific average radiation dose information Describes risks of magnetic resonance imaging (MRI)

Identifies patients at risk for complication of contrast administration and recommends appropriate management Communicates the relative risk of exam-specific radiation exposure to patients and practitioners Accesses resources to determine MRI safety in settings of implanted devices and retained metal

Communicates MR safety of common implants and retained foreign bodies to patients and practitioners

Modifies protocols to minimize radiation exposure for neuroangiographic procedures Evaluates patients at risk for complication of MRI and recommends appropriate management

Educates others in issues related to contrast agent administration Recognizes and manages radiation overexposure for neuroangiographic procedures Promotes radiation safety

Contributes to advancing the field of contrast agents Contributes to advancing the field of radiation safety

Comments:




SBP1: Radiation Safety Level 1 Level 2 Level 3 Level 4 Level 5 Describes the mechanisms of and risks for radiation injury Describes the ALARA principle With supervision, applies basic radiation protection and monitoring concepts

Recognizes signs of radiation injury Communicates the relative risk of exam-specific radiation exposure to patients Requires supervision when employing ALARA principles to minimize radiation exposure to the patient, self, and staff members while optimizing image quality

With limited supervision, consistently employs ALARA principles to minimize radiation exposure to the patient, self, and staff members while optimizing image quality

Consistently and independently employs ALARA principles to minimize radiation exposure to the patient, self, and staff members while optimizing image quality

Performs root cause analysis for recordable or reportable events Develops methodologies to further decrease radiation exposure

Comments:




SBP2: Patient Safety Level 1 Level 2 Level 3 Level 4 Level 5 Recognizes the importance of advocating for quality care and optimal patient care systems Acknowledges that medical errors and health care system failures are a significant cause of morbidity

Understands key concepts related to health care quality improvement Recognizes potential sources of system failure in health care systems, such as medication errors

Advocates for optimal individual patient care in the endovascular environment Recognizes and reports lapses in procedural and medication safety, procedural and medication errors, and near misses

Understands and directs department protocols for patient safety in the endovascular environment Advocates for quality care and supports an environment of safety Participates in a team-based approach to evaluate medical errors and systems-based failures

Participates in the development of national standards for safety in the endovascular environment Leads a team to evaluate medical errors and systems-based failures and improve processes and systems

Comments:




SBP3: Systems-based Management Level 1 Level 2 Level 3 Level 4 Level 5

Identifies the members and roles of the endovascular team and CSC team Participates in transitions of care, including stroke code response

Recognizes need for participation in a multidisciplinary care team Understands principles of procedure coding Presents case analysis at quality improvement review

Coordinates multidisciplinary care of the cerebrovascular patient Practices cost-effective care Understands the role of utilization review

Coordinates system resources and transitions of care for complicated cerebrovascular patients Effectively manages the endovascular team Engages in utilization review Participates in the collection of CSC quality metrics

Creates appropriate use criteria for endovascular therapy Participates in national decision-making for coding and reimbursement of endovascular therapy

Comments:




PBLI: Self-directed Learning Level 1 Level 2 Level 3 Level 4 Level 5 Acknowledges gaps in personal knowledge and frequently asks for feedback Understands the importance of setting learning and improvement goals

Develops learning and improvement goals based on feedback Utilizes online data resources appropriately

Performs ongoing self-assessment and implements individual learning plans Critically appraises scientific literature and applies evidence-based medicine principles for self-improvement as a clinician Participates in a quality improvement project

Engages in performance improvement by incorporating feedback from multiple stakeholders (e.g., patients, members of the health care team, third-party payors) Demonstrates best clinical practice, including use of evidence-based pathways

Creates novel ways to assess performance Applies results from self-directed learning to educating others Completes scholarly activity (e.g., scientific presentation, publication, research)

Comments:



ICS1: Communication with Patients and Families Level 1 Level 2 Level 3 Level 4 Level 5 Recognizes the importance of effective communication with patients, families, and the public across a broad range of socioeconomic and cultural backgrounds Understands privileged communications and HIPPA compliance

Demonstrates effective communication with patients and families Engages in shared decision making when obtaining informed consent

Educates patients and families regarding issues related to cerebrovascular disease Effectively communicates with vulnerable populations, including patients at risk and their families

Obtains informed consent for participation in clinical trials Effectively communicates with patients and families regarding complications and adverse outcomes Leads communication regarding end-of-life and withdrawal of care

Consults on regional and national health care agencies Educates the public regarding cerebrovascular disease risks

Comments:



ICS2: Communication with Health Care Professionals Level 1 Level 2 Level 3 Level 4 Level 5 Recognizes the importance of effective, timely consultation and communication with the health care team Ensures transitions of care are accurately and efficiently communicated Ensures clear communication and respect among health care team members

Demonstrates effective, timely consultation and communication with the health care team in routine clinical situations, including dictated reports Develops working relationships across specialties with other health care professionals

Provides effective, timely consultation and communication with the health care team in critical, time-sensitive situations Provides education to the health care team (e.g., journal club) Participates in peer review

Adapts communication strategies to resolve challenges with consultants and other health care professionals Provides endovascular therapy education to other specialties within his or her own institution

Seeks leadership opportunities within professional organizations Delivers talks to regional or national audiences

Comments:



PROF1: Professional Values Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates behavior that conveys caring, honesty, genuine interest, and sensitivity when interacting with a diverse population of patients, families, and other members of the health care team

Engages in patient-centered care, including demonstrating compassion, integrity, respect, sensitivity, and responsiveness Consistently recognizes ethical issues in practice, including conflicts of interest

Consistently manages own values and beliefs to optimize relationships and medical care Engages in shared decision making to develop alternate care plans when patients’ personal decisions/beliefs preclude the use of commonly accepted practices

Develops and applies a consistent approach to evaluating appropriate care Evaluates possible barriers to care, and creates strategies that consistently prioritizes the patient’s best interest Effectively analyzes and manages ethical issues in challenging clinical situations (e.g., end-of-life, unexpected outcomes)

Develops institutional and organizational strategies to protect and maintain professional and bioethical principles

Comments:



PROF2: Accountability to Patients, Society, Profession and Self Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates basic professional responsibilities, such as timely reporting for duty, responsiveness to consultation requests, appropriate dress/grooming, timely chart completion, and duty hour reporting Maintains patient confidentially Uses social media ethically and responsibly Maintains current licensure, certification, and privileging as required by institutional and national governing bodies

Identifies basic principles of physician wellness, including sleep, hygiene, and fatigue mitigation Consistently recognizes limits of knowledge in common and frequent clinical situations, and asks for assistance

Consistently recognizes limits of knowledge in uncommon and complicated clinical situations Develops and implements plans for the best possible patient care Recognizes and avoids inappropriate influences of marketing and advertising Recognizes and acknowledges potential conflicts of interest

Understands how to identify and confidentially report impairment in one’s self or a colleague Manages medical errors consistent with principles of responsibility and accountability in accordance with institutional policy Serves as a role model for other physicians and health care providers Aware of institutional and national regulations regarding reporting of conflicts of interest

Develops institutional and organizational strategies for physician professional responsibilities Trains physicians and educators regarding responsibility, wellness, fatigue, and physician impairment

Comments:

Documents

The Endovascular Surgical Neuroradiology Milestone Project › Portals › 0 › PDFs › Milestones › ...based on location and imaging features using various diagnostic imaging