Journal of the American College of Radiology : JACR
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The aim of this report is to provide a detailed description of a program employing medical students to assist with triaging off-hour diagnostic imaging studies at a major academic medical center. ⋯ The employment of medical student triage assistants provides in-depth exposure to clinical radiology relatively early in medical school, while providing an effective system to help streamline the off-hour workflow for attending radiologists, residents, technicians, and support staff members.
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Acute chest pain suggestive of acute coronary syndrome is a frequent complaint in the emergency department. Acute coronary syndromes include myocardial infarction and unstable angina. Being able to establish the diagnosis rapidly and accurately may be lifesaving. ⋯ Noncardiac etiologies of chest pain include aortic dissection, aortic aneurysm, pulmonary embolism, pericardial disease, and lung parenchymal disease. Noninvasive cardiac imaging in patients who are at low and intermediate risk for coronary artery disease may improve confidence regarding the safety of discharge from the emergency department. In addition to risk stratification, noncoronary etiologies for chest pain can be established with imaging.
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When all patients are required to pay the same out-of-pocket amount for imaging services, which have varying degrees of benefit dependent on patient characteristics, there is potential for overuse and underuse. Rising costs of health care have stimulated efforts to redesign health care packages. ⋯ With value-based insurance design, cost sharing is still used, but a "clinically sensitive" approach is designed to mitigate the adverse health consequences of high out-of-pocket costs. The authors summarize the principles of value-based insurance design and review examples of its implementation in other areas of medicine.
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As medical education and continuous professional development shift toward an outcomes-based model, there is increasing focus on the documentation of physician self-assessment and a commitment to lifelong learning. The Accreditation Council for Graduate Medical Education is helping prepare trainees for these changes by increasing the focus of graduate medical education on outcomes through the development of the 6 competencies. As part of this process, the learning portfolio is a new component of the Accreditation Council for Graduate Medical Education radiology residency program requirements. The purpose of this article is to familiarize the reader with the role of portfolios in medical education and to discuss strategies for the implementation of learning portfolios in a residency education program.