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THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE 515 N State, Ste 2000, Chicago, IL 60654 (312) 755-5000 www.acgme.org FOR CONTINUED ACCREDITATION GENERAL INSTRUCTIONS REVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDITATION OF A PROGRAM: If the Program Information Form (PIF) is being completed for a currently accredited program, follow the provided instructions to create the correct form. Go to the Accreditation Data System found on the ACGME home page (www.acgme.org ) under Data Collection Systems. Using your previously assigned User ID and password, proceed to the PIF Preparation section on the left hand menu and update the Common PIF data. Most data are updated through annual updates, but some information is required at the time of site visit only. Once the data entry is complete, select Generate PIF to review and print the Common PIF (PDF). Pages will be numbered consecutively in the bottom center of each page. Once the Common PIF is complete, proceed to the appropriate Residency Review Committee webpage to retrieve the Specialty Specific PIF for CONTINUED ACCREDITATION. Once the forms are complete, enter page numbers for the Continued PIF in the bottom center for each page that consecutively follows the Common PIF numbering, combine the Common PIF and the Continued Accreditation PIF and complete the Table of Contents (found with the Specialty Specific PIF instructions). After completing the PIF/documents, make four copies. They must be identical and final. Draft copies are not acceptable. The forms should be submitted bound by either sturdy rubber bands or binder clips. Do not place the forms in covers such as two or three ring binders, spiral bound notebooks, or any other form of binding. Mail one set of the completed forms to the site visitor at least 14 days before the site visit. The remaining three sets should be provided to the site visitor on the day of the visit. The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the designated institutional official of the sponsoring institution. Review the Program Requirements for Residency Education in Nuclear Medicine. The Program Requirements and the Institutional Requirements may be downloaded from the ACGME website (www.acgme.org): For questions regarding: -the completion of the form (content), contact the Accreditation Administrator. -the Accreditation Data System, email [email protected]. Nuclear Medicine Continued Accreditation PIF i

THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE

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Page 1: THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE

THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE515 N State, Ste 2000, Chicago, IL 60654 (312) 755-5000 www.acgme.org

FOR CONTINUED ACCREDITATION

GENERAL INSTRUCTIONS

REVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDITATION OF A PROGRAM: If the Program Information Form (PIF) is being completed for a currently accredited program, follow the provided instructions to create the correct form. Go to the Accreditation Data System found on the ACGME home page (www.acgme.org) under Data Collection Systems. Using your previously assigned User ID and password, proceed to the PIF Preparation section on the left hand menu and update the Common PIF data. Most data are updated through annual updates, but some information is required at the time of site visit only. Once the data entry is complete, select Generate PIF to review and print the Common PIF (PDF). Pages will be numbered consecutively in the bottom center of each page.

Once the Common PIF is complete, proceed to the appropriate Residency Review Committee webpage to retrieve the Specialty Specific PIF for CONTINUED ACCREDITATION. Once the forms are complete, enter page numbers for the Continued PIF in the bottom center for each page that consecutively follows the Common PIF numbering, combine the Common PIF and the Continued Accreditation PIF and complete the Table of Contents (found with the Specialty Specific PIF instructions). After completing the PIF/documents, make four copies. They must be identical and final. Draft copies are not acceptable. The forms should be submitted bound by either sturdy rubber bands or binder clips. Do not place the forms in covers such as two or three ring binders, spiral bound notebooks, or any other form of binding. Mail one set of the completed forms to the site visitor at least 14 days before the site visit. The remaining three sets should be provided to the site visitor on the day of the visit.

The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the designated institutional official of the sponsoring institution.

Review the Program Requirements for Residency Education in Nuclear Medicine. The Program Requirements and the Institutional Requirements may be downloaded from the ACGME website (www.acgme.org):

For questions regarding:

-the completion of the form (content), contact the Accreditation Administrator.

-the Accreditation Data System, email [email protected].

For a glossary of terms, use the following link – http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp

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Have the following documents available for the site visitor:

References to Common Program and Institutional Requirements are in parentheses.

1. Policy for supervision of residents (addressing resident responsibilities for patient care, progressive responsibilities for patient management, and faculty responsibility for supervision) (CPR IV.A.4)

2. Program policies and procedures for residents’ duty hours and work environment (CPR II.A.j.4.; CPR VI.C.; IR II.D.4.i.; IR III.B. 3.)

3. Moonlighting policy (CPR II.A.4.j; CPR VI.F)

4. Documentation of internal review (date, participants’ titles, type of data collected, and date of review by the GMEC)

5. Overall educational goals for the program (CPR IV.A.1)

6. Competency-based goals and objectives for each assignment at each educational level (CPR IV.A.2)

7. Current Program Letters of Agreement (PLAs) (CPR I.B.1)

8. Files of current residents who have transferred into the program, if applicable (including documentation of previous experiences and summative competency-based performance evaluations) (CPR III.C.1)

9. Evaluations of residents at the completion of each assignment (CPR V.A.1.a)

10. Evaluations showing use of multiple evaluators (faculty, peers, patients, self, and other professional staff) (CPR V.A.1.b.(2))

11. Documentation of residents’ semiannual evaluations of performance with feedback (CPR II.A.4.g; V.A.1.b.(4))

12. Final (summative) evaluation of residents, documenting performance during the final period of education and verifying that the resident has demonstrated sufficient competence to enter practice without direct supervision (CPR V.A.2)

13. Completed annual written confidential evaluations of faculty by the residents (CPR V.B. 3)

14. Completed annual written confidential evaluations of the program by the residents (CPR V.C.1.d.(1))

15. Completed annual written confidential evaluations of the program by the faculty (CPR V.C.1.d.(1))

16. Documentation of program evaluation and written improvement plan (CPR V.C)

17. Documentation of resident duty hours (CPR II.A.4.j; VI.D.1-3)

18. Files of current residents and most recent program graduates

Single Program Sponsors only:

1. A copy of the resident contract with the pertinent items from the institutional requirements and Master Affiliation Agreements

2. Institutional policy for recruitment, appointment, eligibility, and selection of residents (IR II.A.)

3. Institutional policy for discipline and dismissal of residents, including due process (IR II.D.4.e.; IR III.B.7.)

Nuclear Medicine Continued Accreditation PIF ii

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THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE515 N State, Ste 2000, Chicago, IL 60654 (312) 755-5000 www.acgme.org

10 Digit ACGME Program I.D. #:Program Name:

TABLE OF CONTENTS

When you have the completed forms, number each page sequentially in the bottom center. Report this pagination in the Table of Contents and submit this cover page with the completed PIF.

Common PIF Page(s)Accreditation InformationParticipating Sites

Sponsoring Institution/Single or Limited Residency Institution (If applicable)Faculty/Teaching Staff

Program Director InformationPhysician Faculty RosterFaculty Curriculum VitaeNon Physician Faculty Roster

Resident AppointmentsNumber of PositionsActively Enrolled Residents (if applicable)Aggregated Data on Residents Completing or Leaving the Program for the last 3 years (if applicable)Residents Completing Program in the Last 3 years (if applicable)Transferred, Withdrawn, and Dismissed Residents (if applicable)

EvaluationResident Duty Hours

Specialty Specific PIF Page(s)Patient Care

Adult Diagnostic Nuclear Imaging StudiesAdult Radionuclide TherapyPediatric Diagnostic Nuclear Imaging StudiesPediatric Radionuclide TherapyDiagnostic Nuclear Nonimaging Studies (Pediatric and Adult)

Medical KnowledgeBasic ScienceClinicalDidactic: OtherOrganizationIn Vivo (Imaging) TrainingTherapy TrainingNon Imaging TrainingPediatric Nuclear MedicineQuality Control and AssuranceResearchResident Duty Hours and the Working Environment

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Specialty Specific PIF Page(s)Practice-Based Learning & ImprovementInterpersonal & Communication SkillsProfessionalismSystems-Based PracticeTraining Other LearnersFacilitiesAppendix A - Goals and ObjectivesAppendix B - BibliographySample Monthly Clinical Conferences

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RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE515 N State, Ste 2000, Chicago, IL 60654 (312) 755-5000 www.acgme.org

SPECIALTY SPECIFIC PROGRAM INFORMATION FORM

I. PATIENT CARE

A. Adult Diagnostic Nuclear Imaging Studies

CPT Codes Site #1 Site #2 Site #3 Site #4THYROID AND ENDOCRINE1. Thyroid Uptake and Thyroid Imaging 78000-780112. Thyroid Carcinoma Metastases

Imaging 78015-78018

3. Parathyroid Imaging 780704. Adrenal Imaging 780755. Other Endocrine 78099TOTALS:HEMATOLOGIC1. Bone Marrow Imaging 78102-781042. Spleen Imaging, Platelet Survival 78185-781913. WBC Localization Imaging 78192-781934. Lymphatic System Imaging and

Sentinel Node Imaging78195

TOTALS:GASTROINTESTINAL1. Liver and Spleen Imaging 78201-782202. Hepatobiliary Imaging 78220-782233. Salivary Gland Imaging, GE Reflux,

Esophageal Motility Gastric Mucosa Imaging, Gastric Emptying

78230-78264

4. GI Blood Loss Imaging 782785. Bowel Imaging, Peritoneal-Venous

shunt Patency78290-78291

TOTALS:BONE IMAGING1. Bone and Joint Imaging (planar) 78300-783102. Bone, Triple Phase Imaging 783153. Bone and Joint Imaging

(Tomographic)78320

4. Bone Density Measurements 78350-78351TOTALS:CARDIOVASCULAR (Excluding PET)1. Cardiac Shunt Detention 784282. Vascular Flow Imaging, Venography 78445-784583. Myocardial Perfusion Imaging (planar) 78460-784614. Myocardial Perfusion Imaging

(Tomographic)78464-78465

5. Myocardial Infarct Avid Imaging 78466-784696. Cardiac Blood Pool Imaging 78472-784737. ECG-Gated Myocardial Perfusion 78478-78480

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CPT Codes Site #1 Site #2 Site #3 Site #4Imaging (tomo)

8. Cardiac Blood Pool First Pass Study 78481-78483TOTALS:PULMONARY1. Pulmonary Perfusion 785802. Pulmonary Ventilation 78587-785943. Pulmonary Quantitative Differential

Function78596

TOTALS:CENTRAL NERVOUS SYSTEM (Excluding PET)1. Brain Imaging (Planar and

Tomographic)78600-78615

2. Cisternography, CSF Dynamics Shunt, CSF leak

78630-78652

3. Isotope Dacrocystograpy 78660TOTALS:GENITOURINARY1. Kidney Imaging/Function 78700-787252. Kidney Imaging/Function with Pharm.

Intervention78726

3. Kidney Transplant Evaluation 787274. Urinary Bladder Residual/Reflux 78730-787405. Testicular Imaging 78760-78761TOTALS:ONCOLOGY/INFECTION (Excluding PET)1. Localization of Tumor 78800-788032. Localization of Abscess 78805-78806TOTALS:PET IMAGING1. Tumor 788102. Cardiac 784593. Neurologic 786084. OtherTOTALS:

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B. Adult Radionuclide Therapy

Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #41. Therapy for Hyperthyroidism 790052. Therapy for Thyroid Carcinoma 79030, 790353. Therapy with Radiolabeled antibodies 794034. Therapy for Painful Bone Disease 79101-777505. Therapy for Polycythemia, Chronic

Leukemia79100

6. Intracavitary or Interstitial Radioactive Colloid Therapy

79200-79300

7. Other Non-Thyroid, Non-Hematologic Cancer Therapy (Specify)

79400-79999

6. Intraarticular Therapy 79440TOTALS:

C. Pediatric Diagnostic Nuclear Imaging Studies

Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4THYROID AND ENDOCRINE1. Thyroid Uptake and Thyroid Imaging 78000-78112. Thyroid Carcinoma Metastases

Imaging78015-78018

3. Parathyroid Imaging 780704. Adrenal Imaging 780755. Other Endocrine 78099TOTALS:HEMATOLOGIC1. Bone Marrow Imaging 78102-781042. Spleen Imaging, Platelet Survival 78185-781913. WBC Localization Imaging 78192-781934. Lymphatic System Imaging 78195TOTALS:GASTROINTESTINAL1. Liver and Spleen Imaging 78201-782202. Hepatobiliary Imaging 78220-782233. Salivary Gland Imaging, GE Reflux,

Esophageal Moltility Gastric Mucosa Imaging, Gastric Emptying

78230-78264

4. GI Blood Loss Imaging 782785. Bowel Imaging, Peritoneal-Venous

shunt Patency78290-78291

TOTALS:BONE IMAGING1. Bone and Joint Imaging 78300-783102. Bone, Triple Phase Imaging 783153. Bone and Joint Imaging

(Tomographic)78320

4. Bone Density Measurements 78350-78351TOTALS:

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Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4CARDIOVASCULAR (Excluding PET)1. Cardiac Shunt Detention 784282. Vascular Flow Imaging, Venography 78445-784583. Myocardial Perfusion Imaging 78460-784614. Myocardial Perfusion Imaging

(Tomographic)78464-78465

5. Myocardial Infarct Avid Imaging 78466-784696. Cardiac Blood Pool Imaging 78472-784737. ECG-Gated Myocardial Perfusion

Imaging78478-78480

8. Cardiac Blood Pool First Pass Study 78481-78483TOTALS:PULMONARY1. Pulmonary Perfusion 785802. Pulmonary Ventilation 78587-785943. Pulmonary Quantitative Differential

Function78596

TOTALS:CENTRAL NERVOUS SYSTEM (Excluding PET)1. Brain Imaging (Planar and

Tomographic)78600-78615

2. Cisternography, CSF Dynamics 78630-78652TOTALS:GENITOURINARY1. Kidney Imaging/Function 78700-787252. Kidney Imaging/Function with Pharm.

Intervention78726

3. Kidney Transplant Evaluation 787274. Urinary Bladder Residual/Reflux 78730-787405. Testicular Imaging 78760-78761TOTALS:ONCOLOGY/INFECTION (Excluding PET)1. Localization of Tumor 78800-788032. Localization of Abscess 78805-78806TOTALS:

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D. Pediatric Radionuclide Therapy

Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4Therapy of Hyperthyroidism 79000-79020Therapy for Thyroid Carcinoma 79030-79035Therapy for Polycythemia, Chronic Leukemia

79100

Intracavitary/Interstitial Therapy 79200-79300Other Non-Thyroid, Non-Hematologic Cancer Therapy

79400

Intravascular Particulate Therapy 79420Intraarticular Therapy 79440TOTALS:

E. Diagnostic Nuclear Nonimaging Studies (Pediatric and Adult)

List the number of each type of Nuclear Medicine procedures performed in those departments which participate in the nuclear medicine residency.

Test: CPT Codes Site #1 Site #2 Site #3 Site #4Glomerular Filtration Rate 78725Effective Renal Plasma Flow 78725Schilling Test 78270Red Cell and Plasma Volume 78120-78122Other (Specify)TOTALS:

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II. MEDICAL KNOWLEDGE

A. Basic Science

1. Instruction that focuses on physical principles, computer applications instrumentation, or techniques of measurement and quantification should be listed under the subheading of BASIC SCIENCE

Basic Science Lecture Hrs Lab. HrsTotal Hours per Academic Year

Physical Science and InstrumentationRadiation Biology & Radiation ProtectionComputer ScienceMathematics and StatisticsComputer Processing of Clinical ImagesRadionuclide Chemistry and RadiopharmacyTotal Basic Science Hours

2. Provide a complete Basic Science didactic schedule (conferences and lectures) for the most recent academic year. The schedule must be complete and accurate, and must provide the title/topic of each session, date, presenter name.

Title/Topic Date Presenter Name

3. Provide a description of the Basic Science didactic schedule by diagramming a typical weekly schedule of these conferences with a brief textual explanation.

Time Monday Tuesday Wednesday Thursday Friday7:00 a.m.8:00 a.m.9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.

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B. Didactic and Clinical

Time in supervised clinical training or clinical conferences should not be included in this tabulation. Instruction that deals with biologic principles, in vivo tracer kinetics and clinical applications should be tabulated under the CLINICAL subheading.

Clinical Lecture Hours Lab. HoursTotal Hours per Academic Year

Nuclear ImagingCNSCardiacPulmonaryGIInfectionEndocrineMusculoskeletalHematology/OncologyRenalPET: Technical aspects & instrumentationTherapy of HyperthyroidsmTherapy of thyroid cancerTherapy with radiolabeled antibodiesOther radionuclide therapy (specify)In Vitro Assays (Methodology and application) GFR, Schilling Test, etc.In Vivo Measurement (Methodology and application) thyroid uptake, bone density, etc.Pediatric Nuclear MedicineQuality Management & ImprovementOther (Specify)

1. Provide a complete clinical didactic schedule (conferences and lectures) for the most recent academic year. The schedule must be complete and accurate, and must provide the title/topic of each session, date, presenter name, and number of hours.

Title/Topic Date Presenter Name Number of Hours

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2. Provide a description of the clinical didactic lectures and clinical case conferences listed above, by diagramming a typical monthly schedule of these conferences (a sample schedule is provided at the end of this document) with a brief textual explanation.

Time Monday Tuesday Wednesday Thursday Friday7:00 a.m.8:00 a.m.9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.7:00 a.m.8:00 a.m.9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.7:00 a.m.8:00 a.m.9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.7:00 a.m.8:00 a.m.9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.

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3. Describe how residents participate in the conferences listed above. How much responsibility do they have for their preparation and presentation?

C. Other

Total Hours per Academic YearJournal ClubLectures Presented by ResidentsAdministrative Conferences (i.e., QA)Other (specify):

D. Organization

1. Goals and Objectives

a) A complete set of goals and objectives must be available for the site visitor. Choose as a sample the goals and objectives for one clinical rotation and attach as Appendix A (do not append all of the goals and objectives).

b) When are the goals and objectives distributed to faculty?.......................................................................( ) Prior to each rotation ( ) Annually ( ) Other

2. Describe the organization of the educational program.

3. Explain the provision for graduated resident responsibility and resident supervision.

E. In Vivo (Imaging) Training

1. Describe the provisions made in your program for didactic instruction and for practical experience and training in the full spectrum of in vivo imaging studies, including positron tomography.

2. Describe the arrangement for interdepartmental collaboration regarding in vivo imaging studies when applicable. The description should include, for example, the role of the Nuclear Medicine resident in the performance of cardiac studies and the relationship between Cardiology and Nuclear Medicine in the performance and interpretation of cardiac studies. If collaborative arrangements exist for other organ systems, these should be described as well.

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F. Therapy Training

1. Describe the formal instruction devoted specifically to radionuclide therapy applications including dosimetry, physics, radiobiology and radiation safety.

2. Describe the clinical participation in the therapeutic applications of radionuclides.

3. Describe the provision for resident participation on the follow-up of therapy patients.

4. If the Nuclear Medicine division or department shares the responsibilities for radionuclide therapy with other divisions, describe the roles of each division and/or each participating site.

G. Non Imaging Training

(Non imaging training includes instruction in the principles of immunology; preparation of radiopharmaceuticals including radiolabeled antibodies; radiopharmaceutical absorption, excretion and dilution studies).

1. Describe the provisions made in your program for didactic instruction and for practical experience and training in the full spectrum of non imaging procedures.

2. If the Nuclear Medicine Department or Division shares the responsibility for non-imaging procedures with other divisions and/or participating sites, describe the roles of each division and/or participating site by identifying who is responsible for performing and interpreting the results of non-imaging studies.

H. Pediatric Nuclear Medicine

Describe the arrangements for training in pediatric nuclear medicine.

I. Quality Control and Assurance

Describe briefly the quality management and improvement for nuclear medicine and the role of the resident in these plans. The quality control plan should include quality control of instrument performance and of radiopharmaceutical preparation. The quality assurance plan should include efficacy assessment and compliance with NRC and JCAHO regulations. Describe how residents participate in quality management and improvement activities.

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J. Research

Describe briefly the space and special facilities for Nuclear Medicine research.

K. Resident Duty Hours and the Working Environment

1. Describe nuclear medicine residents' work hours including night and weekend call. Indicate the frequency of call and availability of faculty supervision.

2. Explain how the program deals with impaired residents.

Limit your response to 200 words.

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III. PRACTICE-BASED LEARNING AND IMPROVEMENT

Examples of Learning Activities: didactic lecture, assigned reading, seminar, self-directed learning module, conference, small group discussion, workshop, online module, journal club, project, case discussion, one-on-one mentoring, or other examples of learning activities.

1. Describe one learning activity in which residents will engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; identify and perform appropriate learning activities to achieve self-identified goals (life-long learning).

Limit your response to 400 words.

2. Describe one example of a learning activity in which residents will engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients’ health problems. The description should include:

a) locating informationb) using information technologyc) appraising informationd) assimilating evidence information (from scientific studies)e) applying information to patient care

Limit your response to 400 words.

3. Give one example of a planned quality improvement activity or project in which at least one resident will participate that will require the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that will guide this process.

Limit your response to 400 words.

4. Describe how residents:

a) develop teaching skills necessary to educate patients, families, students, and other residents;b) teach patients, families, and others; and c) receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is

used to evaluate these skills have it available for review by the site visitor.)

Limit your response to 400 words.

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IV. INTERPERSONAL AND COMMUNICATION SKILLS

1. Describe one learning activity in which residents will develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health related agencies.

Limit your response to 400 words.

2. Describe one learning activity in which residents will develop their skills and habits to work effectively as a member or leader of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities.

Limit your response to 400 words.

3. Explain (a) how the completion of comprehensive, timely and legible medical records will be monitored and evaluated, and (b) the mechanism that will be used for providing residents feedback on their ability to competently maintain medical records.

Limit your response to 400 words.

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V. PROFESSIONALISM

1. Describe at least one learning activity, other than lecture, by which residents will develop a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Limit your response to 400 words.

2. How will the program promote professional behavior by the residents and faculty?

Limit your response to 400 words.

3. How will lapses in these behaviors be addressed?

Limit your response to 400 words.

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VI. SYSTEMS-BASED PRACTICE

1. Describe the learning activity(ies) through which residents will achieve competence in the elements of systems-based practice:  work effectively in various health care delivery settings and systems, coordinate patient care within the health care system;  incorporate considerations of cost-containment and risk-benefit analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in interprofessional teams to enhance patient safety and care quality.

Limit your response to 400 words.

2. Describe an activity that will fulfill the requirement for experiential learning in identifying system errors.

Limit your response to 400 words.

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VII. TRAINING OTHER LEARNERS

If the program provides rotations for residents or fellows from other specialties either within or from outside the site provide the number of trainees, trainee specialty, whether the rotation is observation or full participation, and length of time spent in your department.

Trainee Specialty

# of trainees per year at any

given timeFull

Participation ObservationalLength of Rotation

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VIII. FACILITIES

1. Nuclear Medicine Equipment: List number of units in use in each site. Use institution numbers from. If more than four sites participate in the program, duplicate this table as needed.

Site #1 Site #2 Site #3 Site #4In Vitro Laboratory

Gamma Well SystemLiquid Scintillation SystemDose CalibratorChromotography

In Vivo Imaging/CountingProbe Counting SystemsCamerasPlanarMobileSPECT (not SPECT/CT)SPECT/CTPET (not PET/CT)PET/CT

Computer Access (yes/no)Nuclear Medicine PACSRadiology PACSRadiology Information SystemHospital Information SystemDesignated Resident Computers (How many?)

Radiopharmaceutical ChemistryCyclotronOther (Specify)

2. Institutional Patient Data: supply the following data for the most recent 12 month period available. Use institution numbers from. If more than four sites participate in the program, duplicate this table as needed.

From To

Site #1 Site #2 Site #3 Site #4Total Number of Active BedsHospital Admissions:

PediatricAdultTotal

Outpatient Visits: PediatricAdultTotal

3. Accreditation and Licensure for Nuclear Medicine: Indicate by Yes/No and date.If more than four sites participate in the program, duplicate this table as needed.

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Accreditation and/or Licensure(Indicate by Yes/No and date) Site #1 Site #2 Site #3 Site #4Quality Assurance Programs

Society of Nuclear Medicine/ICANL (Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories)American College of RadiologistsCLIA (Clinical Laboratory Improvement Amendments)

Other (Specify)

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APPENDIX A GOALS AND OBJECTIVES

Attach a sample of the goals and objectives for one clinical rotation

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APPENDIX B BIBLIOGRAPHY

List no more than 10 representative publications from the past three years by members of the nuclear medicine teaching staff and residents. Underline the names of resident participants.

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SAMPLE MONTHLY CLINICAL CONFERENCES

Time Monday Tuesday Wednesday Thursday Friday7:00 a.m.8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1)9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m. 12-1 Rad Onc

Conf. (2)12-1 Endo Conf.

(3)1:00 p.m.2:00 p.m.3:00 p.m. 3-4 PET Conf. (1)4:00 p.m.5:00 p.m.7:00 a.m.8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1)9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.7:00 a.m.8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1)9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m. 12-1 Endo Conf.

(3)12-1 Neuro Sci

Conf. (3)1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.7:00 a.m.8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1)9:00 a.m.10:00 a.m.11:00 a.m.12:00 p.m.1:00 p.m.2:00 p.m.3:00 p.m.4:00 p.m.5:00 p.m.

* Site Code: 1 – Site #1 A; 2 – Site #2; 3 – Site #3

Nuclear Medicine Continued Accreditation PIF 21