University of Ottawa Diagnostic Radiology Residency Program

The Diagnostic Radiology Program is committed to the safety of its residents and faculty. It strives for a culture of safety whereby any resident may report an adverse event(s), critical incidents, or patient safety concerns without fear of retribution. The program encourages residents to bring forth any safety concerns to the Program Director or any member of the Residency Training Committee at any time. Site-specific concerns should ideally be brought first to the attention of the RTC Site Coordinator. All concerns will be handled in a confidential fashion.

It must be recognised that the responsibility for resident safety is jointly shared between the resident, residency program, Faculty of Medicine, University of Ottawa and its affiliated Hospital Sites, and Ontario Ministry of Health & Long Term Care. Residents must observe universal precautions and isolation procedures when indicated.

This policy complies with the Royal College accreditation standards A2.5 and B3.1.9 and does not supersede any University wide or Health Services Policy that is also established. Residents should also refer to the University of Ottawa Postgraduate Medical Education Faculty of Medicine Occupational Health and Safety Policy (Publication pending as of May 2011).

There are multiple components to resident safety, addressed as follows:

Educational Activities

Residents involved in educational activities (interviewing patients, obtaining informed consent, performing procedures, etc.) should perform such activities either with other members of the health-care team (faculty, nurses, technologists) in the room or in close proximity, to ensure their safety with regards to unsuspected violent or inappropriate behavior by a patient towards the resident. Residents required to participate in these educational activities as part of their on-call responsibilities in an isolated department (e.g. on-call ultrasound examination at night) must have another member of the health care team (or hospital security as appropriate) with them or in very close proximity.  Residents should not assess violent or psychotic patients without the backup of security and a supervisor and also an awareness of accessible exits.

Radiation exposure

All residents can expect to be protected in the same fashion as patients and other members of the public, faculty and staff with regards to radiation exposure within the department from its computed tomography and radiography facilities as per the relevant Ontario Ministry of Health & Long Term Care policy and procedures. Residents involved with any educational activities involving radiation exposure (image-guided fluoroscopic procedures) will be expected to wear appropriate apparel (lead apron or lead vest/skirt combination with thyroid shield and protective eyewear) or will not be allowed to participate in these activities. The site radiology department will be responsible to have this apparel available for residents.

MR Safety

All residents are expected to participate in an MR safety orientation session provided by the program with the assistance of the chief MR technologist from a major teaching site. All residents are expected to comply with MR safety protocols and procedures as outlined by the site Radiology Department and Ontario Ministry of Health & Long Term Care.

Pregnancy

Pregnant residents may have specific risks to themselves and the fetus. Therefore their training environment and their duties may be modified to minimize these risks.  Residents who are pregnant may approach the Program Director to restructure rotation schedules to limit radiation exposure or remove themselves from such environments on specific rotations (e.g. fluoroscopy or Nuclear Medicine).  On-call duties during pregnancy shall be in compliance with the PAIRO-OCATH agreement.

Travel

Residents are encouraged to utilize resources provided by hospital and site security (e.g. security escorts) when travelling or working in isolated locations on-call or during daytime working hours, including parking facilities. Home visits or air transports are not required of any resident in the program at any time. Residents traveling for clinical or other academic duties by private vehicle should maintain their vehicle adequately and travel with appropriate supplies and contact information. If the resident has determined that it is unsafe to travel (e.g. due to extreme weather concerns) they may elect not to attend their rotation or academic half day but are expected to inform the program administrator and their supervising radiologist immediately. Residents doing home call and arriving after hours should be aware of their environment before leaving their car and have an operational cell phone available to contact security if it is deemed an escort is required.  If a resident has identified a potential threat to their safety in a site parking lot or similar, then they should not leave their vehicle but rather notify hospital security or police services for assistance.  Residents should be aware that driving home when tired post-call may put them at risk of having an accident.  Residents are advised to either find an alternate means of transportation home, or sleep in the on-call room prior to driving home if they feel that they cannot safely drive home.

On-call

Resident shifts on-call will be in accordance with the PAIRO-OCATH collective agreement and PGME policy.  On site call rooms should offer the resident a safe, clean and protected environment. Security escorts should be available for on-call residents to off-site call rooms.

Environmental Health

All incidents should be reported to the relevant hospital’s or the Ontario Ministry of Health & Long Term Care Office of Occupational Health, Safety and Wellness and will be addressed as per their policies and procedures.

Occupational Health and Safety

This is under the auspices of the Faculty of Medicine and Ontario Ministry of Health & Long Term Care. Please refer to the aforementioned PGME Occupational Health and Safety Policy (In Press) for details.

Personal Health and Safety

All hospital sites are responsible for the safety and security of residents in their facilities and on their premises as per their own safety and security policies and in accordance with PAIRO requirements.

Psychological Safety

Any incidents dealing with intimidation or harassment should be handled as per the program policy on conflict resolution. Issues relating to substance abuse or psychological illness should be brought to the attention of an RTC representative or the Program Director and will be handled on case-by-case basis utilizing the PGME resident wellness program and/or resources provided by PAIRO and/or resources provided by the CPSO.

Professional Safety

Issues with regards to ethical/religious beliefs will be handled on a case-by-case basis. Residents will be provided support with regards to adverse events or critical incidents by all parties (program, PGME, Ontario Ministry of Health & Long Term Care as per existing policies and procedures). Any breach in confidentiality of personal information should be brought to the attention of an RTC representative.

Medico-legal Issues

It is the expectation of the program that all residents are members of the Canadian Medical Protection Agency (CMPA). Residents must be members of the CMPA and are encouraged to follow CMPA recommendations in the case of real, threatened, or anticipated legal action. The Program Director and the RTC can guide residents towards helpful resources within the CMPA should a threat of legal action be made against them whilst in the program.

Resident Responsibilities

Residents must participate in safety sessions required and provided by the Postgraduate Medical Education Office and/or Ontario Ministry of Health & Long Term Care including Fire Safety, Workplace Hazardous Materials Information and safety (WHMIS) Infection control, and follow the safety codes of the site where they are training. Residents must report any situation where personal safety is threatened and should be aware of the contact for security at participating training sites. They are expected to maintain immunizations and TB testing up to date. Overseas travel immunizations and advice should be organized well in advance when traveling abroad for electives or meetings.

Diagnostic Radiology Residency Program

Introduction

The Diagnostic Radiology Resident Training Committee functions as an advisory committee to the Director of DI Resident Training Program in matters related to Diagnostic Radiology Residents. The Committee is charged with solving problems, proposing policies and improving the Resident Training Program. In the event of a disagreement between residents in training, Department of Diagnostic Radiology at TOH or CHEO, Department of Postgraduate Medical Education and the of Physicians and Surgeons, the Committee acts as the agent in assisting the negotiation between the different parties.

The DI Residency Training Committee meets nine times yearly. 

Four meetings are general purpose meetings.  The remaining 5 meetings deal with general items, but also deal with one of the following (in chronological order)

• Formal rotation review

• Selection of residency interview candidates

• Candidates interviews

• Chief Resident selection

• Yearly resident promotion

Additional meetings are added as required.

Membership of the Committee

The Committee is chaired by the Director of the Diagnostic Radiology Resident Training Program. 

Resident membership consists of:

• Chief Resident

• Junior Resident Representative

• Senior Resident Representative

The Chief Resident is chosen by the RTC at the May meeting.  All RTC members participate in the discussion and vote with the exception of any resident who is presently an RTC member but is being considered for the position.  The Chief resident term is from July 1 to June 30 of the following year.  The Chief Resident is typically in their PGY4 year.

The Junior Resident Reporesentative is chosen in May or June by the PGY1 and PGY2 residents at the time of the vote and will represent the PGY1, PGY2 and PGY3 residents from July 1 to June 30.  This resident is typically a PGY3 resident during their term.

The Senior Resident Representative is also chosen in May or June by the PGY3 and PGY4 residents at the time of the vote and will represent the PGY4 and PGY5 residents from July 1 to June 30.  This resident is typically a PGY4 resident during their term.

Staff Radiologist Core members are appointed by the Committee Chair in consultation with the remaining RTC members.  The appointed members shall hold office for two years with appointment of new members occurring at the September RTC meeting. Reappointments of the same Committee members for another term of office are permitted.

The core members represent relevant subspecialties.

• Pediatric radiology

• Breast

• Thoracic and cardiac imaging

• Neuroradiology

• Nuclear medicine

• MSK imaging

• GI, GU

• ER

• Vascular / interventional radiology

The Pediatric radiology seat is often shared by two Radiologists both based at the Children’s Hospital of Eastern Ontario (CHEO). 

The remaining radiologists are based at The Ottawa Hospital.  As TOH radiologists routinely work at all three campuses, there are no site specific RTC members other than those representing CHEO.

The five remaining RTC members are considered Corresponding Members in that they are invited to attend all meetings but are only required to attend those meetings were issues relating to their specific areas are to be discussed.  These are:

• University of Ottawa Diagnostic Radiology Chair

• The Ottawa Hospital Diagnostic Radiology Chief

• Head of Diagnostic Radiology at CHEO

• TOH Diagnostic Radiology Research Director

• TOH Diagnostic Radiology Undergraduate Education Director

• TOH Diagnostic Radiology Academic Affairs Committee Chair.

• University of Ottawa Postgraduate Medical Education, Vice-Dean (ex-officio)

Finally, individuals involved in issues relevant to specific meetings are often invited to attend the RTC proceedings and participate in the discussion. Residents and staff not on the RTC but who wish to discuss an item with the committee are welcome to do so.

Functions of the Committee

• Advise the Program Director on matters of policy and procedure.

• Ensure the program meets the standards of accreditation.

• Provide opportunities for residents to attain all competencies outlined in the objectives of training.

• Select candidates for admission to the program.

• Evaluate and promote residents in the program.

• Assist in the appeal mechanism and other matters between the Radiology Residents and the Royal College of Physicians and Surgeons, the University of Ottawa Postgraduate Education Committee, and other training programs.

• Provide career planning and counseling.

• Establish mechanisms to deal with outstanding problems.

• Review the program to assess the educational experience, teachers, resources and facilities available to ensure maximal benefit.

• Ensure the aims and objectives of the Training Program are appropriate and to review them regularly.

• Ensure that residents understand and respect ethical and medicolegal issues related to the practice of radiology.

Sub Committees under RTC

Curriculum Committee

Terms of Reference

• Sub-committee of RTC (approved by RTC)

• Chaired by Associate PD

• Members: PD, Associate PD, Resident RTC members, PGY1 resident representative, PGY1 curriculum co-ordinator, SIM committee staff

• Minutes and agenda to be kept by PA

• Meet at least twice per year (2 RTCs to be replaced, ~May & December)

• Mandate:

• Oversee residency program formal curriculum including but no limited to:

• Academic Half-Days

• Simulation Workshops

• Rounds

• Visiting Professors

• Physics

• PGY1 Curriculum

SIM Committee

• Sub-committee of Curriculum Committee

• Coordinator: R. Hibbert

• Members: M. McInnes, G. Doherty, A. Gupta, S. Peddle, K. Rakhra

• Mandate: Oversee simulation curriculum including workshops and lectures pertaining to procedural training:

• Interdisciplinary Simulation Workshops (Anesthesia/Radiology, PGY1)

• Radiology Simulation Workshops (PGY2-5)

• Procedural Academic Half-Day lectures

Promotions Committee

• Sub-committee of the RTC

• Coordinator: Program Director

• Members: Program Director, Associate Program Director, Chief Resident

• Mandate: Oversee annual promotions/remediation of residents

University Of Ottawa Diagnostic Radiology Policy On Annual Resident Evaluation And Promotion

Every year, each PGY2 to PGY5 resident participates in three objective evaluation exercises: the ACR written examination, the OSCE, and the oral examination. In addition to these examinations, the resident performance on rotations and in the professionalism domain will be assessed.

The purpose of these evaluations is to identify as early as possible residents who are not progressing as expected, who may be at risk of not successfully completing the Royal College examination process, or who not be able to acquire the skills required for independent practice. Once identified, the evaluation process should also provide useful information to determine the most appropriate intervention(s) to help the resident return to an expected level of performance.

The following table describes the minimum performance standard for each of these domains, and suggests approaches to a resident who does not meet this standard in a given

Professionalism

Satisfactory attendance at departmental educational activities including academic half day, visiting professor and resident rounds. Missing 2 or more such events per block without cause (illness, vacation, post call, excused by PD) will be considered below the minimum performance standard. Other activities constituting unprofessional behavior (intimidation or harassment, unprofessional inter-professional interaction, ethical or privacy transgressions) will also be considered.

Performance Below Minimum Standard

A resident who does not meet the minimum standard is considered to be performing below expectations in that domain.

Resident performance in each domain will be discussed first by the resident promotion committee, then at the time of the year-end meeting with the Program Director. Performance below the minimum standard in any domain will be specifically discussed. The reasons for the low performance will be explored, and a plan will be formulated to avoid this from recurring.

The degree of intervention required will depend on the specific details of the type, degree of and plurality (how many domains) of below-expectations performances.

Some of the tools which my be recommended by the Promotions sub-committee are as follows:

• Specific advice or additional training on taking that particular type of examination/ domain.
• Additional learning strategies.
• Supervised learning or teaching sessions.
• Formal remediation.
• Probation.
• Extension of training.
• Repetition of a specific PGY year.

Deferral of Royal College Examination

The promotions committee determine the best strategy for a return to expected performance. Any recommendations for remediation or probation will first be discussed by the promotions sub-committee with the chief resident serving as resident advocate. If formal remediation, probation, extension of training, repetition of a year, or deferral of the exam are recommended by the promotions sub-committee,these will be presented to the Residency Training Committee for approval (typically at the June meeting). The RTC may recommend changes to this strategy. Following approval by the RTC, approval by the PGME evaluations committee is required.

Any decision by the RTC and PGME evaluations committee may be appealed by a resident according to the University’s Guidelines for appeals. These guidelines are in the resident handbook and on the PGME web-site .

Maintaining a Collegial and Professional Environment — Disruptive Physician Policy University of Ottawa Diagnostic Radiology Residency Program

Approved: Nov 25, 2014.

The establishment and maintenance of a healthy, collegial and professional working environment is paramount to ensure that the welfare of our patients is always first and foremost in our thoughts and actions as physicians and radiologists.

Disruptive behavior within the health care delivery team damages the cohesiveness and effectiveness of the team and places our patients at risk. Disruptive behavior can manifest as the use of inappropriate or disparaging language, inappropriate actions and/or inappropriate inactions.

Inappropriate inactions may include repetitive punctuality and attendance issues on service and/or for mandatory program events. Additional examples of inappropriate actions/inactions include: a lack of engagement within the health care team; failing to work cooperatively or collaboratively with others; creation of inflexible barriers to requests for assistance; repeatedly failing to answer phone calls and/or pages asking for information and/or service assistance; and, a failure to be available when expected to be present and accountable.

Disruptive behavior creates additional stress upon the learning process within our Diagnostic Radiology Residency Program, particularly when our learners feel unsafe to contribute or engage in quality health care delivery and positive educational experiences.

The Diagnostic Radiology Residency Training Committee (RTC) has adopted the CPSO “Guidebook for Managing Disruptive Physician Behaviour” to define and guide the management of unprofessional and disruptive behavior within the residency program¹. This guidebook has a more complete list of examples of unprofessional and disruptive behavior.

In the event that a resident within the Diagnostic Radiology Residency Program is either the focus of disruptive behavior or is identified as a disruptive physician, prompt action to understand the reported incident will be initiated by the Chief Resident or another resident representative of the RTC and the Program Director.

Appendix G, of the CPSO “Guidebook for Managing Disruptive Physician Behaviour”¹, has been modified to guide the behavioral management of all disruptive physician behavior within the residency program. All confirmed incidences of disruptive behavior will be managed in a staged response as described in the following ‘Disruptive Behavior Staged Management’ description.

Note: A similar process exists at the hospital, departmental and university level for staff physicians and other personnel. Any concerns from residents about disruptive behavior regarding such individuals should be brought to the PD and or Associate PD and will be directed towards the appropriate individuals for action.

Disruptive Behavior Staged Management

(adapted from the CPSO “Guidebook for Managing Disruptive Physician Behaviour”, Appendix G)

Stage 1 Response

1. Confirm facts of report;

2. Notify resident and/or other involved physician(s);

3. Discovery process—ask all involved parties to discuss their perspective on the incident;

4. If a resident is named as the disruptive party and the discovery process finds no merit to the accusation, the incident will be expunged from the e-mail records and not recorded in the resident’s file;

5. If the accusation is found to have merit, each party will be invited to meet face-to-face for a discussion of the incident with the Program Director (or Associate PD) acting as a mediator;

6. Obtain assessment of cause;

7. Obtain a verbal commitment from the disruptive physician that the disruptive/unprofessional behavior will not be repeated;

8. If a resident is named as the disruptive party, the incident will be recorded in the resident’s file;

9. Consider establishing a peer mentor;

10. Follow up/monitor future behavior.

Stage 2 Response

If disruptive behavior is repeated:

1. Confirm facts of report;

2. Notify resident and/or other involved physician(s);

3. Discovery process—ask all involved parties to discuss their perspective on the incident;

4. If a resident is named as the disruptive party and the discovery process finds no merit to the accusation, the incident will be expunged from the e-mail records and not recorded in the resident’s file;

5. If the accusation is found to have merit, each party will be invited to meet face-to-face for a discussion of the incident with the Site Supervisor(s) and/or the Program Director acting as a mediator;

6. Obtain assessment of cause;

7. Obtain a written commitment from the disruptive physician that the disruptive/unprofessional behavior will not be repeated;

8. If a resident is named as the disruptive party, the incident will be recorded in the resident’s file;

9. Consider referral to the Office of Resident Wellness to discuss techniques to better manage stress, or other events which may lead to disruptive behaviors;

10. If a resident is named as the disruptive party, and if the incident occurs during an “After-Hours” service period, consider assigning a more senior resident to act as a back-up to future “After-Hours” service periods in an effort to promote positive modeling behaviors;

11. Follow up/monitor future behavior.

Stage 3 Response

If disruptive behavior is repeated, again:

1. Confirm facts of report;

2. Notify resident and/or other involved physician(s);

3. Discovery process—ask all involved parties to discuss their perspective on the incident;

4. If a resident is named as the disruptive party and the discovery process finds no merit to the accusation, the incident will be expunged from the e-mail records and not recorded in the resident’s file;

5. If the accusation is found to have merit, each party will be invited to meet face-to-face for a discussion of the incident with the Site Supervisor(s) and/or the Program Director acting as a mediator;

6. Obtain assessment of cause;

7. If resident has reliably demonstrated a pattern of disruptive physician behavior, the resident will be presented to the RTC Promotions Subcommittee.  The resident will be notified of this presentation and will be invited to testify in front of the committee. The resident may choose to have representation and support from the Chief Resident (or another RTC resident representative) at the meeting.

8. The promotions subcommittee may decide to refer the resident to the Post-Graduate Medical Education (PGME) office for remediation of professionalism.

9. Mandatory referral to the Office of Resident Wellness to discuss techniques to better manage stress, or other events which may lead to disruptive behaviors;

10. If a resident is named as the disruptive party, and if the incident occurs during an “After-Hours” service period, a more senior resident will be assigned to act as a back-up to future “After-Hours” service periods in an effort to promote positive modeling behaviors;

11. Follow up/monitor future behavior.

Stage 4 Response

If there is persistent disruptive behavior, following a Stage 3 Response:

1. Repeat steps 1-10 as in the ‘Stage 3’ response.

2. Consider obligation to notify CPSO.

University of Ottawa Diagnostic Radiology Program Resources for Resident Well-Being & Stress Management

The University of Ottawa Diagnostic Radiology Program Strives to maintain a stress-free and positive work environment. Many resources are available to the residents to deal with stress within the program:

• Mentorship Program
• RTC Members
• Program Administrator
• Chief Resident and RTC representatives

Should the above local resources prove insufficient, the resources below may be of additional assistance:

• OMA Physician Health Program (PHP) for members 1-800-268-7215 x2972
• PAIRO 24 help line for residents and their families 1-866-HELP-DOC (1-866-435-7362)
• Monique Beaulne (Resident Well Being) - 737-8473
• University of Ottawa Faculty of Medicine Wellness Program (Dr. Gerin Lajoie) 613-562-5800 ext 8507

These numbers and more are on the UofO PGME website

Residents should also refer to the Resident Well-Being Handbook provided by the PGME office in the resident handbook.

Overall Goals & Objectives

Diagnostic Radiology

The Diagnostic Radiology Training Program is an accredited program through The University of Ottawa and takes place predominantly at The Ottawa Hospital (TOH) and the Children’s Hospital of Eastern Ontario (CHEO).

The overall goal of the program is to train residents to be successful, well-qualified Radiologists, fulfilled in their future careers.

The program provides training to residents through involvement in clinical work, participation in educational activities, conferences, academic half days and research.

The training program functions in accordance with the principles of the RCPSC CanMEDS project.

The five year program is structured to meet the objectives and specialty training requirements in Diagnostic Radiology established by the Royal College of Physicians and Surgeons of Canada (RCPSC) and to allow eligibility for board examinations of both the Royal College and the American Board of Radiology (ABR).

The radiology residents work alongside surgeons, medical specialists, family physicians, oncologists, pathologists and other health care professionals to provide state-of-the-art medical care.

The program is committed to providing research experiences for residents. Residents are expected to have at least one audit or research project underway by PGY2, completed by PGY3 and presented at Research Day by PGY4.

Training follows the general principle of graded responsibility which should have the resident functioning as a junior staff by the PGY5 level.

The resident education environment should be free of harassment or intimidation. All complaints in this regard are taken very seriously. Similarly, residents are expected to act in a professional manner.

Resident performance will be regularly evaluated, and residents will be given the opportunity to evaluate their preceptors in an anonymous fashion.