Evolution of nuclear medicine training: past, present, and future.

Since the official inception of nuclear medicine in 1971, the practice of nuclear medicine and its training programs have undergone major revisions. Numerous procedures that were common in the 1970s are no longer available, and many new radiotracers and procedures have since been developed. Training programs have evolved from an unstructured experience before 1971 to 2 y of nuclear medicine training after 2 clinical years, to 2 y of nuclear medicine training after 1 clinical year and, most recently, to 3 y of nuclear medicine training after 1 clinical year. The most substantial content changes in the new 2007 training program requirements are an increased emphasis on 6 clinical competencies, an increased emphasis on Nuclear Regulatory Commission requirements, and a new CT training requirement that was spawned by the advent of PET/CT. In addition to the new training program requirements, residents will need to become familiar with the concept of maintenance of certification, which will continue to be an important component of their professional careers. Nuclear medicine is gradually evolving into molecular imaging. Hence, it is inevitable that in the near future, training programs will be required to place greater emphasis on molecular imaging in both clinical and research applications. The incorporation of molecular imaging will represent a significant paradigm shift for the specialty but will ensure that nuclear medicine will be a major part of medical practice for the foreseeable future.     

19个亚太国家医学物理职业体系调查分析

目的 了解19个亚太国家医学物理师职业体系,为我国医学物理师的职业发展提供国际参考经验。方法 对19个亚太国家的医学物理师代表进行个人深入访谈,调查内容涉及个人基本信息,所在国医学物理师规模、学历、职称、专业背景、海外教育及培训、收入、职业吸引力、认证、教育资源、时间分配、离职原因等。利用主题框架法对访谈资料进行分析。结果 根据访谈,各国医学物理师的规模均不大;硕士及以上学位已成为12个国家医学物理师的最低要求;8个国家建立了独立的医学物理师职业认证和准入体系;9个国家建成了独立的医学物理师职称体系;收入是影响医学物理师职业吸引力的主要因素;质量控制是澳大利亚、印度尼西亚、日本和新加坡医学物理师的主要工作内容,投入时间不低于50%。结论 根据研究结果,通过对比19个亚太国家医学物理师的职业体系发现,我国医学物理师缺口较大,医学物理专业学位教育规模较小,医学物理师职业认证的准入门槛较低,且尚无独立的医学物理师职称体系,在收入水平、工作内容及时间分配等方面也与发达国家存在一定差距。国家和行业组织需要在高等教育、职业认证、职称体系、责任定位等方面加大投入力度,逐步建立与完善医学物理师的职业体系及准入标准。     

How shall we train?

The prosecution of modern war and the competing missions of peacekeeping, humanitarian missions, and beneficiary care place great demands on the military medical system. Meeting the military medical training challenges of the new millennium requires the best trained and most experienced medical personnel possible. Various strategies for initial and sustainment (continuing) medical training are available to ensure that the medical force is ready for the next mission. Accredited programs both in and out of the military are the mainstay of training for both enlisted personnel and officers, with professional certification serving as the standard for competency. Clinical sustainment training can take place in military medical treatment facilities, civilian institutions, or a combination of the two. When direct patient care opportunities cannot provide the proper mixture of experiences to maintain certain skills, short courses, distance education, and patient simulators can play important roles. Because each training strategy offers certain advantages in different settings, it is likely that military medical departments will need to use all of them. An optimal training environment benefits from all strategies used, in combination or separately.     

Methods and resources for physics education in radiology residency programs: survey results

Over the past 2 years, ongoing efforts have been made to reevaluate and restructure the way physics education is provided to radiology residents. Program directors and faculty from North American radiology residency programs were surveyed about how physics is being taught and what resources are currently being used for their residents. Substantial needs were identified for additional educational resources in physics, better integration of physics into clinical training, and a standardized physics curriculum closely linked to the initial certification examination of the American Board of Radiology.     

Nuclear medicine training and practice in Poland

In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes regular postgraduate training for physicians working in NM. Educational programs are comprehensive, covering both diagnostics and current forms of radioisotope therapy. They are aimed not only at physicians specialized/specializing in NM, but also at other medical professionals employed in radionuclide departments as well as physicians of other specialties.     

A quantitative comparative study of medical dosimetry graduates with and without prior radiation therapy certification

All but a small number of formal medical dosimetry programs require radiation therapy certification for admission. The problem is a lingering perception from the radiation oncology community that medical dosimetry students must have a prior radiation therapy certification and/or experience. There is a paucity of evidence in the literature to support the perception that prior radiation therapy certification equates to better job performance as a medical dosimetrist. The purpose of this quantitative comparative study was to investigate outcomes of medical dosimetry graduates with and without prior radiation therapy certification (RTT and non-RTT). The researcher used archival records to examine comparison data of medical dosimetry graduates with and without radiation therapy certification including track of enrollment, admissions cumulative grade point averages (CGPA) and science grade point averages (SGPA), medical dosimetry program GPAs, radiation therapy work experience, Medical Dosimetrist Certification Board (MDCB) exam pass rates, program completion rates, and job placement rates. Surveys were used to collect and analyze data from clinical supervisors at affiliate internship sites and from employers of program graduates. Key findings from the quantitative study revealed that no relevant differences existed between RTT and non-RTT medical dosimetrist graduates with regard to GPA and program effectiveness data. However, for RTT and non-RTT students combined, there were significantly lower GPAs noted for individuals who did not graduate from the program or graduates that did not pass the MDCB exam on first attempt. Thematic findings from the surveys revealed non-RTT medical dosimetrist students/graduates required more initial training and supervision and differences were noticed among the non-RTT medical dosimetrist students/graduates based on their prior degree. Clinical supervisors and employers had no reservations about hiring RTT or non-RTT medical dosimetry graduates from the program.     

Postgraduate radiology training in sub-Saharan Africa: a review of current educational resources

RATIONALE AND OBJECTIVE: Postgraduate training programs in radiology exist in several African nations. The ability of these programs to train radiologists is necessarily affected by local availability of educational resources, including clinical case volume, radiology equipment and maintenance, number of teaching faculty, and library and computer facilities. We sought to determine the current resources of a sample of African radiology education programs. MATERIALS AND METHODS: Site visits were conducted at three separate radiology training programs, one in Ghana and two in South Africa. At each site, the investigator conducted a technology census, assessed library resources, observed daily trainee activities, and interviewed trainees, faculty, and statisticians. RESULTS: African radiology trainees receive considerable training in fluoroscopy, ultrasound, and plain film radiography, but receive considerably less training in nuclear medicine, mammography, magnetic resonance imaging, and interventional radiology. A large amount of equipment in African teaching hospitals is inoperative because of lack of maintenance programs. Faculty to resident ratios in African teaching hospitals are much lower than in American hospitals. Needs of training programs vary greatly from hospital to hospital, and from country to country. CONCLUSION: Radiologists, radiology organizations, and radiology vendors from high-income nations are in a unique position to help Africa's postgraduate radiology training programs fulfill their mission of training Africa's next generation of radiologists. It is desirable that long-term commitments be made to teaching hospitals so that scarce donated resources may be put to the best possible use.     

Resident training in breast imaging in Canada: current status.

The authors evaluated the current status of resident training in breast imaging in Canada to provide baseline data for guidelines on the amount and the nature of training necessary. Information was obtained, by means of a questionnaire or a telephone interview, from the directors of all 16 radiology residency programs and the 58 radiology residents in their final year at the time of the study. All programs offer training in breast imaging; the training is mandatory in 11 (69%) and elective in 5 (31%). Of the 58 residents, 52 had had some training in breast imaging at the time of the study. Of these, 24 (46%) had spent a period averaging 3.9 weeks exclusively on breast imaging. Forty-one percent of residents felt that the duration of their breast imaging training was too short, and 35% felt that they could not practise mammography independently after their rotation. The authors found that training in breast imaging across the country is highly variable. Although this training is being upgraded in many programs, deficiencies remain. Guidelines are needed to ensure a minimum standard for training in breast imaging.     

High-dose fluoroscopy: the administrator's responsibilities

During the past 15 years, developments in x-ray technologies have substantially improved the ability of practitioners to treat patients using fluoroscopically guided interventional techniques. Many of these procedures require a greater use of fluoroscopy and serial imaging (cine). This has increased the potential for radiation-induced dermatitis, epilation and severe radiation-induced burns to patients. Radiology administrators must realize that these high-dose procedures increase the risk for radiation injury and radiation-induced cancer in personnel as well as in patients. This article discusses particular clinical cases and describes positive, pro-active steps that practitioners and administrators can take to help prevent such injuries in their facilities. Unfortunately, with the exception of radiologists, a large proportion of physicians who use fluoroscopy have effectively no training or credentials in management of radiation or the biological effects associated with its use. In 1994, an FDA advisory warned that training of physicians for modern-day use of the fluoroscope was for the most part insufficient and needed to be expanded. Many prominent medical organizations such as the American College of Cardiology (14) and the American Heart Association (15) have published strongly worded position papers agreeing that there is an urgent need for such training. The consensus is that "rubber-stamp" privileges (16,17) to perform fluoroscopic procedures should no longer be granted. At present, the JCAHO is considering the implementation of a statement regarding JCAHO standards and privileges for practitioners to use fluoroscopic x-ray equipment. Whether or not the JCAHO becomes involved, it is becoming increasingly clear that all practitioners who use fluoroscopic radiation should be required to complete focused training in radiation physics, radiation biology and radiation safety. Training should include the pertinent aspects of radiation management in the clinical setting so that these physicians will be able to acceptably control risks to patients and personnel. The task of securing these materials and lecturers and documenting everything may fall on the shoulders of the radiology administrator or radiation safety staff. Completion of an approved educational program (with appropriate testing) provides the evidence needed by the facility to approve the practitioner's qualifications. In summary, it will take a concerted effort on the part of professional medical organizations and regulatory agencies to insure that the wealth of preventative information now available is disseminated to and put to use by these physicians who may fail to fully appreciate the potential for imparting serious injury to their patients. Even one radiation injury caused by lack of education is unacceptable.     

Ways to improve training of the populace for rendering medical first aid to casualties in extreme situations

The article presents the results of population' training for rendering the first medical aid in the cases of extreme situations, fulfillment of the normative document requirements on the problem The study was conducted in All-Russian Center for Disaster Medicine "Zaschita" of Russian Health Ministry. It is shown that after publication of normative documents the rescuer and special contingent training has improved, at the same time the training of other population groups doesn't meet the requirements. The current programs and forms of population education, insufficient number of educational time and pore material and technical basis don't provide the necessary knowledge and skills on rendering the first medical aid in the cases of extreme situations. Basing on the study the following documents were developed: the unified program "The First medical aid", the test program to control the students' knowledge, the methodical manuals for teachers and students and the standards of class equipping.     

Performance of military-trained physician assistants on the physician assistant national certification examination

Although the first physician assistant (PA) program was born at a civilian academic institution, the impact of the military was immediately obvious as evidenced by the entire first class of PA students being Vietnam veteran Navy Corpsmen. Following initiation of the PA profession, the armed services established their own PA training programs that were eventually consolidated into a single interservice program in 1996. The mission of the Interservice PA Program is to produce high-quality PAs prepared to provide medical care in not only the traditional clinical arena but in the more unique situations seen in both peacetime and wartime military settings. PAs must complete an approved formal training program encompassing didactic and clinical training and pass a national certification examination to be licensed to practice. Pass rates are a key measure of the quality of a training program. We compared the national certification examination pass rates for our program with those of accredited civilian programs. Graduates of our program had a significantly higher pass rate and higher average scores than their civilian counterparts. These results are due to the strength of the program and faculty as well as the considerable hard work and dedication of the students who are drawn from a community that is, in many ways, non-traditional compared with other PA programs. These results demonstrate that the military training of PAs continues to provide high-quality health care providers who perform above their civilian-trained counterparts.     

Assuring a trained workforce for allied health: the administrator's role

In many areas healthcare education has failed to keep pace with changing needs for new skills and characteristics. The Project on the Future of Allied Health solicited a number of white papers detailing characteristics, competencies and attitudes that will be required of allied health workers in 2005. Two concepts from those white papers pertain especially to radiology: (1) the knowledge burden of today's health professional is quickly approaching overload and (2) manufacturers of healthcare equipment and technology must bear some responsibility for the problems and solutions. Some large employers have determined that allied health education is not providing appropriate training and have initiated their own programs. New models of allied health education and practice already exist around the country. It is no longer "if" but "how" we can make progress toward change. The impetus and funding for new programs probably will not come from the government; leaders in the industry must implement changes in education and staff development. Radiology administrators and professional associations must play a role in redesigning programs for allied health training.     

The new FAA national automated ECG network: some aviation medical examiner experiences

The Federal Aviation Administration (FAA) has required, since August 1, 1987, that aviation medical examiners (AMEs) transmit by telephone all electrocardiograms (ECGs) necessary for airman "Class I" medical certification. This relatively new airman certification requirement is centralized at the Civil Aeromedical Institute (CAMI) in Oklahoma City. In calendar year 1989, the FAA received 69,000 electronically transmitted electrocardiograms. CAMI uses Marquette Electronics software to interpret the ECG signals that are received from multi-channel equipment. The single-channel transmitted ECGs are hand screened at present. The FAA "automated" screening program is unique among governmental airman medical certification programs throughout the world. This paper presents, for potential future users, the authors' experiences with the new airman automated electrocardiographic certification requirement, and covers positive and negative features involved in the implementation and operation of the program. We conclude that while the new FAA automated ECG screening program has satisfactorily replaced the former "physician-intensive" manual screening process, the new system increases the AME's equipment and operation costs. These are passed on to the airman who is seeking certification.     

成都市新都区公立医疗机构卫生人力资源现状调查

目的摸清成都市新都区公立医疗机构卫生人力资源现状,找出问题,提出相应的解决对策。为政府及医疗机构制定卫生可持续发展战略及合理开发与配置卫生人力资源提供科学的参考依据。方法采用普查法,对全区公立医疗机构卫生人力资源的数量、质量、构成、分布等方面进行统计分析。结果卫生人力资源总量相对不足,而在公立医疗机构中卫生人力资源相对过剩,人员年龄结构断层、学历层次偏低、专业职称层次偏低、无证卫生专业技术人员偏多、分布不合理、农村卫生人力素质较低、人力资源管理体制僵化。结论应充分认识卫生人力资源的重要性,加强卫生人才队伍建设,优化卫生人力资源配置,创新卫生人才激励机制,充分激发人才的成长愿望、积极性和创造性。     

EMS certification requirements for flight nurses

INTRODUCTION: Emergency medical technician (EMT) or paramedic (EMTP) certification requirements for flight nurses (FNs) providing on-scene patient care vary. We surveyed those requirements and evaluated the relationships between flight team composition or program location and FN EMS certification. METHODS: Telephone survey of all 184 rotor-wing programs responding with a nurse to scenes RESULTS: The overall EMS training requirement for FNs was: none-57.6%, EMT-21.7%, EMTP-14.7%, local credential (not EMT or EMTP)-6.0%. Second team members were EMTP, RN, physician, or respiratory therapist (RRT). Overall, team configuration related significantly to FN EMS certification (P =.01). FN/EMTP and FN/RRT teams were individually significant (P <.01), with FN/EMTP teams tending not to require certification and all FN/RRT teams tending toward a certification requirement. Neither FN/FN nor FN/physician pairings related significantly with FN EMS certification requirements. Regional patterns emerged to both crew configuration and FN EMS certification requirements. CONCLUSION: Most flight programs do not require FN EMT/EMTP certification. Team configuration and geography are related to those requirements.     

Zertifizierungen im Gesundheitswesen

A quality certification is nowadays an important competitive factor for clinics and other institutions in Germany. The best known procedures are certification according to the norm DIN EN ISO, the German certification procedure in the healthcare system KTQ (Cooperation for Quality and Transparency in Healthcare) and the procedures of the German Cancer Society or medical professional societies. The majority of German clinics, centers, practices and nursing institutions are certified according to one of these procedures. In some areas certification is mandatory and a prerequisite for patient care, e.g. for rehabilitation institutions. But even in the field of acute medicine certification is an important proof that quality requirements have been fulfilled and has an effect on the economic situation. The aim of a visitation or audit is always to check whether the requirements of the appropriate certification procedure have been fulfilled. The actual procedure and the course can however, be organized differently. The failure to obtain certification is a very unpleasant situation for all concerned and can have negative effects on the image of the institution. Such a failure can most probably be avoided by good preparation and if necessary external consultation or internal qualification by colleagues. In most cases the certificate can be successfully obtained at least by the second attempt. Appropriate regulations are made by all procedures. Basically a thorough cost-benefit analysis should be carried out before deciding to apply for certification.     

Other models for training radiologists

Different models for training radiologists are used in different countries. Considering the trend toward international homogenization, it is important to know the differences and common traits among different countries to enable us to adapt our programs to future changes. We review training programs in radiology in Europe, the United States, Canada, and some Latin American countries. We focus on the selection process, residency programs, research, certification, subspecialization, and maintaining certification. We found a wide variability among countries, although there are more similarities within continents.     

Medical capacity building efforts in northern Iraq 2009-2010

The authors provide some back ground and general concepts for medical stability operations or medical civil military operations. Some novel programs were developed in northern Iraq, which have applicability to the greater military medical community. Train the trainer emergency medical technician and first aid course curriculums were developed and translated into Arabic and Kurdish and implemented by U.S. medics throughout northern Iraq. The Division also contracted with implementing partners to train first aid and midwife training in Iraqi and U.S. Government priority locations. The implementing partners included 6 nongovernmental organizations and international organizations. These programs were closely synchronized with the Department of State and the United States Agency for International Development to ensure unity of effort and sustainability.     

北京市核医学2019年基本情况调查分析

目的:全面了解北京市医疗机构核医学发展现状,为国家相关主管部门合理配置医疗资源和制定相关医疗政策提供参考数据。方法:采用问卷调查形式,对2019年北京市拥有核医学相关科室的医疗单位进行调查。调查问卷的发放采用现场当面呈送与电子邮件相结合的方式。调查内容包括医疗机构或科室的概况、业务设置、影像设备规模、科室人员、诊疗工作...