Harvey Jennifer A, Nicholson Brandi T, Rochman Carrie M, Peppard Heather R, Pease Clinton S, DeMartini Nicholas A
Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.
Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.
J Am Coll Radiol. 2014 Jun;11(6):600-5. doi: 10.1016/j.jacr.2014.01.007. Epub 2014 Apr 26.
Residency is historically an apprenticeship, learning through observation and instruction with varying degrees of structure. Since July 2013, the Next Accreditation System (NAS) of the ACGME has required the use of progressive milestones for each radiology residency rotation. The authors describe how a breast imaging curriculum can be structured to comply with the NAS. The breast imaging rotations move from basic recognition and management of suspicious findings, through the detection of more subtle findings and learning of biopsy skills, and finally to the synthesis and management of more advanced findings. Likewise, patient communication moves from sharing imaging findings to the more challenging situation of breaking the bad news of a cancer diagnosis. This progression of skills mirrors the objectives of levels 1 to 4 of the NAS. Learning objectives have been adapted to form very specific milestones for each rotation, which results in a shared responsibility between residents and faculty members. Using clear expectations may improve the uniformity of teaching, resident satisfaction, and facilitate performance review for residents who are struggling. Didactic lectures, case-based conferences, teaching file cases, and assigned readings provide different approaches to education, allowing variation in learning styles. Performance on the breast imaging section on the ACR Diagnostic Radiology In-Training examination at our institution has risen from below the 50th percentile to around the 80th percentile beginning in 2011.
从历史角度来看，住院医师培训是一种学徒制，通过观察和指导进行学习，其结构程度各异。自2013年7月起，美国毕业后医学教育认证委员会（ACGME）的下一代认证系统（NAS）要求在每个放射科住院医师培训轮转中使用渐进式里程碑。作者描述了乳腺影像课程如何构建以符合NAS要求。乳腺影像轮转从对可疑发现的基本识别和管理开始，逐步发展到检测更细微的发现并学习活检技能，最后是对更高级发现的综合与管理。同样，与患者的沟通也从分享影像结果发展到面临传达癌症诊断这一坏消息的更具挑战性的情况。这种技能的递进反映了NAS 1至4级的目标。学习目标已被调整以形成每个轮转非常具体的里程碑，这使得住院医师和教员之间形成了共同责任。明确期望可能会提高教学的一致性、住院医师的满意度，并便于对有困难的住院医师进行绩效评估。理论讲座、基于病例的会议、教学档案病例和指定阅读提供了不同的教育方式，允许学习风格存在差异。从2011年开始，我们机构的住院医师在ACR诊断放射学在职考试乳腺影像部分的成绩从第50百分位以下提高到了约第80百分位。
