RTC Meeting Minutes May 21, 2008 - Department of Medical Imaging

University of TorontoDepartment of Medical ImagingUniversity of TorontoRTC Meeting MinutesMay 21, 2008Room NCSB-1C551, Toronto General HospitalAttendeesDr. Linda Probyn – Chair Dr. Robert Bleakney Dr. Jeff JaskolkaDr. Jane Wall for Dr. Robyn Pugash Dr. Hemi Dua Dr. Anshu RajputDr. Lisa Ehrlich – conference call Dr. Melissa Kern Dr. Anisa MnyusiwallaDr. Vik Prabhudesai Dr. Peter de Maio Dr. Cathy MacDonaldRegretsDr. Patrice Bret Dr. David Mikulis Dr. Errol Colak1. Minutes of Previous MeetingThe RTC minutes were approved and will be posted on the resident website and e-mailed to the faculty.2. Business Arisingi)Uploading of past RTC Minutes to Resident website (Resident concern fromApril 23, 2008 meeting):Dr. Probyn informed the Committee that both March and April 2008 Minutes havebeen uploaded to the website and future minutes will be uploaded as well.ii)Non-Medical Imaging residents reviewing studies (Resident concern fromApril 23, 2008 meeting):The residents reported that many non-Radiology residents do not know how to orderimaging studies and access the preliminary reports resulting in many unnecessarypages on-call. All site coordinators will ensure that site manuals be updated directingall non-Medical Imaging Residents so they are aware of how to order imaging tests,view images, reports, etc…

3. Resident Issuesi) Increased on-call volume at Sunnybrook (SB):Dr. Hemi Dua brought forward the above issue to the Committee. Dr. Probynhas been made aware of the issue and has notified Drs. Pugash and Moody.Discussion revolved around the increasing pressures at each University ofToronto teaching site particularly regarding increasing demands from the ERDepartments.Action plan:a) Dr. Probyn has asked other Canadian Program Directors to give estimates ofResident on-call volumes.b) Each site coordinator will audit Resident on-call volumes at each site.c) The numbers will be reviewed once available and options to address thisissue will be discussed at that time and will be addressed at each site asnecessary.4. Restricted Registration - Guest: Laura Silver, PGMELaura Silver discussed current requirements and expectations for participating in theProvincial limited licensure pilot program. Sample guidelines and statistics were brieflyreviewed. Currently, there are 10 programs in place, with Radiology applicants being thehighest of the medical specialties to apply.Summary of presentation:What is Restricted Registration?:Restricted Registration (RR), also known as “limited licensure” is defined as: “Residentsregistered in postgraduate medical education programs leading to certification with theRoyal College of Physicians and Surgeons of Canada or the College of Family Physiciansof Canada who provide clinical services for remuneration outside of the residencyprogram.” (Council of Ontario Faculties of Medicine).Objectives identified by the various stakeholders involved in the project:• provide residents additional practice, collaborative and managerial experienceand develop RCPSC and CFPC roles• provide physician resources to the Ontario health care system in bothacademic and community locations to help meet service needs, including oncalland weekends• improve the financial well being of Residents• provide evidence as to the impact of restricted registration activity on the wellbeing of residents and their families, significant others and personalrelationshipsRequirements:A Resident must:• abide by the terms and conditions of the PAIRO/CAHO Collective Agreement(i.e. not work more than the hours/shifts stipulated by the contract, TBD)

The committee unanimously approved the document. This will now be presented to theExecutive Committee.Dr. Probyn and the Committee thanked Dr. Becker for her hard work, presentation andclarifications at today’s meeting. Dr. Becker agreed to present this document to the entiregroup of residents.6. PGY2 Call Preparedness (Graded Call Responsibilities) – Sub CommitteepresentationDr. Susan James, Dr. Melissa Kern and Dr. David Kelton represented the sub-committee toreview the PGY2 graded call responsibilities (other sub-committee members – Dr. AnisaMnyusiwalla, Dr. Hemi Dua, Dr. Bob Bleakney and Dr. Linda Probyn).Results of the “On-call survey” were reviewed.Most Residents felt that the system of graded call responsibilities for the PGY2 residents in2007 was worthwhile.Some areas of concern raised by the survey include:-high volumes of cases on-call for the level of training-Interpretation of MRI studies and head and neck studies (senior residents (sometimes aPGY3) not confident backing up the PGY2 for these studies)Based on the results of the survey a system of PGY2 graded call responsibilities was draftedby the committee and slightly modified with input from the RTC.The PGY2 graded call responsibilities for 2008 will be as follows:Summer Buddy Call:• PGY2 Buddy call will begin July 7/08, with a 1 in 7 call frequency (PGY2s willbe placed on call schedule (dates to be determined by them))• Total of 8 calls to be completed in periods 1 and 2– 6 weekday calls (5-10pm)– 1 Friday night (5-9am)*– 1 Saturday (9am-9am)**to be completed in August• July: strictly shadow call (learn the admin aspects of call, workflow, becomecomfortable with the system, read studies)• August: PGY2 to take pager, read studies (increasing levels of responsibility)Junior/Senior Call:• When a PGY2 resident is scheduled to be on-call, the PGY2 (“junior”) residentwill be primary on-call, backed up by a PGY3-5 (“senior”) resident• UHN: Senior call to be taken by PGY 4 and 5• SMH, SB: Senior call to be taken by PGY 3-5**All residents must have home access, be in-house or be available to return tothe hospital to view images.

• Start: Tues. Sept.2/08• End: Fri. Dec.19/08• For the duration of Junior/Senior call, PGY-2 residents will have a 1 in 7 callfrequency• Mandatory in-house time for Senior residents:Weekdays:– Sept/Oct: 5pm-9pm*– Nov: 5pm-7pm *– Dec: home call*Weekends:– Sept-Nov: 4pm-8pm*– Dec: home call **provided the jr resident is comfortable AND volume is manageable. If necessary, the Seniorresident continues to stay in house• When the Senior resident is not in house they are on “home/backup call”, and willcontinue to be accessible to the junior for advice, interpretation, help withvolume, etc.• Junior residents should call staff directly if there is an image interpretationquestion whereby a delay in diagnosis would have immediate impact or bedetrimental to the patient• Responsibilities of Senior Resident:– Support and advice– Assist with volume– Assist with interpretation, protocolling, etc.– Teaching around cases (time permitted)• Senior resident will be assigned “out-of-hospital call” as defined by PAIROcontract.• Senior residents will qualify for a post-call day if they are called into the hospital,or work from home after midnight, OR if they are in hospital for 4 consecutivehours with 1 past midnight.• When an PGY2 is on independent call (or during junior/senior backup, if a PGY-3is providing backup):– All complex head and neck CT’s and all MRI studies require a doubleread by a fellow or staff prior to providing the preliminary report.Dr. Probyn thanked Sub-Committee (Susan James, Anisa Mnuysiwalla, Hemi Dua, David,Kelton, Robert Bleakney, Melissa Kearn) for their work on this project.Other changes to improve the PGY2 call preparedness are as follows:a) Summer Intro Lecture SeriesDrs. Anshu Rajput and Melissa Kearn are organizing the summer introductory lectureseries. All PGY3s must do a presentation.

) ExamsThe PGY2 residents will do 2 exams prior to starting independent call (1. On-linecall preparedness exam provided by Indiana University 2. In-house OSCE exam toinclude a clinical and anatomy portion)c) RotationsPGY2 rotations have been scheduled as much as possible so that the core rotations(neuro, abdomen, CT, MSK, Chest) are at the beginning of the year and VIR andBreast are later in the year.d) U/S CourseAn introductory hands-on ultrasound course has been added. This will occur in thefall (after the LMCC2) and will consist of a total of 12 hours teaching withultrasound technologists.7. Next RTC Meeting: Wednesday, June 18, 20088. Other BusinessDeputy Chief ResidentDr. Probyn proposed having a Deputy Chief Resident (to start in July 2008) and willbecome the University Chief Resident in January 2009. This change is suggested sothat the Deputy can attend the Chief Resident Workshop in August and will be able toassist the current Hospital Chief Resident (the Deputy Chief will have an 18 monthterm). The RTC unanimously agreed to this proposal. This system will continue sothat a Deputy Chief Resident is chosen from the PGY3 year every July.RTC Resident Membership ChangeThe year representatives will change in July 2008. It was proposed that this bestaggered (to change in July or December) so that there is more continuity amongstthe resident members. It was suggested that 2 years remain on the RTC untilDecember. The members will consider this proposal.Kathryn O’KeefeRecording SecretaryMeeting adjourned at 6:50 p.m.