Maintain appropriate protocol, courtesy, tact, and confidentiality in business communication, both written and oral.
Correspondence: letters and memos
Demonstrate an appropriate level of communication skills when orally presenting professional or scholarly work.
Demonstrate technical writing ability in a variety of venues, including scholarly writing and business communications.
Write an abstract according to published standards.
Prepare a poster for presentation at a professional conference.
Write scholarly articles.
Develop patient procedure protocols.
Develop department policies.
Write business correspondence such as business letters, memos, or internal reports.
Prepare reports, such as a needs assessment or progress report.
Develop action plans for quality improvement projects.
Develop patient education materials.
Apply concepts of teaching and learning theories in design, implementation and evaluation in the education of patient, family, colleagues and the community. (See Practice-based decision making competency domain.)
Overview for the Practice-based Decision Making Curriculum NMAAs will be expected to demonstrate competency in a wide range of clinical practice including the ability to track, analyze and improve practice processes and outcomes. Inasmuch as the advanced associate represents a “new” cohort of technologists, it is also intended that these individuals develop and evolve a new culture that will include practice of the science of nuclear medicine. With new credentials will come new expectations and duties, and with these, their interactions with and among other technologists, physicians and patients will begin to move to a different level.
The inclusion of the term “Practice” in the title is intentional and implies that that the NMAA is expected to reach beyond the technical aspects of their careers to embrace and master skills in the area of evidence-based practice and decision making, taking on a greater degree of responsibility for the overall quality of the nuclear medicine departments and the care that patients receive while there. Unlike following existing guidelines and manuals, the NMAA will be required to seek out, gather, analyze and act on a combination of quantitative and qualitative data as they work towards proactively improving the totality of the experiences associated with the department.
As the number and experience-base of NMAAs grow, it is anticipated that these individuals will begin to work collectively through their own networks to alter the “organizational citizenship behavior” of our departments to reflect those things that are done to enhance the processes and experiences of the job beyond the basic job descriptions. The key point for prospective students is that they must be willing to and capable of analyzing and improving their own practice behaviors through self-reflection, a practice that is essential to self-improvement. This does not imply that evidentiary considerations will take a back seat but recognizes the need for balancing the unique context that we each function within as we try to bring everything together to create the best environment and outcomes within that particular context or construct. The Accreditation Council for Graduate Medical Education (ACGME) has stated that “…practitioners should be leaders in making change rather than reacting to changes made by others. Positive changes in one’s own practice behavior can have positive effects on larger systems.”
Practice-based Decision Making Curriculum Content
Track and analyze processes, procedures and outcomes using appropriate statistical and/or qualitative techniques.
Use the evidence-based medicine (EBM) process of asking, acquiring, appraising, applying, and assessing to improve clinical practice.
The EBM process
Start with the patient
A clinical problem or question arises out of the care of the patient
The question: construct a well built clinical question derived from the case
Type of question
Diagnosis: how to select the interpret diagnostic tests
Therapy: how to select treatments to offer patients
Prognosis: how to estimate the patient's likely clinical course over time and anticipate likely complications of disease
Etiology: how to identify causes for disease
Other possible questions (e.g., cost, risk, achievability, meaning, etc.)
Prioritizing competing clinical questions
The resource: select the appropriate resource(s) and conduct search
Types of scientific evidence
Animal research/laboratory studies
Case series/case reports
Case control studies
Randomized controlled trial
The evaluation: appraise the evidence for its validity and applicability
The patient: return to the patient
Integrate evidence with clinical expertise and patient preferences
Apply it to practice
Self-evaluation: evaluate performance with this patient
Analyze practice organization and management and perform practice based improvement activities.
Clinical practice evaluation
Number of exams performed per year
Number of full-time employees working in department
Regulatory and accreditation agencies
Customer service (patient/referring physician)
Timing (wait times too long?)
Flow/scheduling (service flow seamlessly or fragmented?)
Accommodation (flexible enough to meet special requests?)
Anticipation (customers' needs anticipated?)
Communication (communication accurate and timely?)
Customer feedback (know what customers are saying and thinking?)
Organization and supervision (how effective/efficient are procedures and protocols?)
Comparisons between NMAA and NMT scopes of practice
Level of supervisory responsibility
Amount of autonomy
Judgment/critical thinking/decision making
Standards of Practice
Define a standard of care and role of practitioner
Establishes criteria used to judge performance: quality assurance
Standards established for clinical practice, technical activities and professional responsibilities
Role of standards of practice within work place
Used to develop job descriptions
Used to develop departmental policies
Used to develop performance appraisals
Used in quality assurance programs as a means of evaluating and improving care.
Used in medical malpractice or negligence cases regarding accepted standards of care
Standards of practice development
Developed from research and the actual practices (prevailing practices) of professionals
Developed from analysis of standards of related professionals
Developed from established benchmarking programs
Critically evaluate current literature and extant research to assess the effectiveness of diagnostic and therapeutic procedures.
Identify and assess the relevance of and utilize credible sources of information.
Critically evaluate studies and research to determine the appropriateness of the type of research done and its relative validity
Reflect on the merits of descriptive vs. explanatory approaches given a specific context and/or construct
Select the most appropriate research methodology
Sources of information that patients may commonly access in literature or online
Determine applicability and completeness of information, clarifying patients’ questions and misunderstandings about procedures, conditions, and assumptions based on what they may have read or been told about their study.
Use findings from literature and benchmarks to design and initiate appropriate research to investigate a given clinical situation in order to arrive at an optimal solution.
Determine whether the research will be best undertaken at a formal or informal level taking into consideration several factors
Significance or severity of problem
Cost of not responding
Universality of problem
Generalizability of the proposed solution or findings
Scope of problem
Identify and clarify the research question reflecting on the optimal approaches
Rank order and prioritize the key issues
Gather and sort data
Seek feedback and agreement with key stakeholders
Pilot test any instruments designed to gather data and analyze the feedback to critically assess effectiveness
Identify the population to be studied
Determine the best approach to sample that population
Select the study sample after carefully considering the following factors
Population and sample
Random or intentional
Cohort or stratified
How should the study sample be characterized?
Reflect on the appropriate sample size after analyzing the demographics of the population and focus of the study
Based on the study’s purpose critically evaluate each of the possible methods for identifying and selecting sample members
Determine whether to use a Quantitative and/or a Qualitative research approach after considering the following factors
Extent to which the study is seeking to build on extant knowledge or investigate new concepts and territory
Degree to which the methodology is congruent with the research question, topic or problem
Contemplate and consider what other types of research might be helpful
Create a clear, comprehensive and workable hypothesis and based on that include the following actions, findings and safeguards.
Decide whether the study should utilize participants or subjects
Ensure that issues of ethics and approval have been adequately addressed
Complete a critical analysis of the literature and disseminate the findings as appropriate citing representative sources
Address issues of potential bias in the study sample to ensure that the study’s findings and conclusions results have high validity
If using a qualitative approach contemplate, propose and utilize multiple alternative approaches to assess and assure study validity
When selecting the study instruments to be used to collect data reflect on the following considerations:
If appropriate should norm or criterion referenced tests be chosen
If performance is being assessed should optimum or typical performance be chosen as the best design for the study
Contemplate the overall experimental or study design in order to
Consider the use of descriptive and/or inferential statistics and be able to provide a clear rationale for that choice including a description of how nominal data will be measured
Basic Concepts of Measurement
Variables and measurement scales
Populations and Samples
Methods of Sampling
Organizing and Grouping Data
Measure of Central Tendency (e.g., mean, median, mode)
Measures of Variability (e.g., standard deviation, variance)
Prediction and Regression
Analysis of Variance
Interpretation and Use
Be able to analyze, interpret and explain the effects of variance and sample size on the statistical tools and data
Use feedback and observations to verify that changes were implemented to optimize patient care delivery and outcomes were effective.
Utilize established research techniques to gather data from patient interviews and assessments in order to monitor the success, effectiveness and quality of patient examinations, therapies, interventions and education.
Utilize these data and their analysis to educate peers and disseminate findings.
Critically evaluate patient test results and images – on an individual basis, and using retrospective, longitudinal and meta-analysis – to validate the quality of care, maintain ongoing improvements and seek methods and approaches to meaningfully participate in ongoing quality control and improvement.
Carefully monitor the ratio of true positives to false positives in light of the context of the variables that affect these in order to assure that patient care and study quality meets or exceeds expected standards.
Through ongoing and active participation in education and personal reflection, seek alternative objective measures that can be used to enhance practice, improve quality and assure patient comfort and safety.
Use information technology to effectively access, collect, analyze and disseminate data.
Use current information technology and other sources to efficiently locate and retrieve relevant information from credible sources.
Follow ethical principles in using information that may be sensitive.
Be aware of appropriate regulations or legislation involving information sharing, storing, protecting, or deleting sensitive information.
Provide discipline-specific education to patients, students, colleagues, and the public.
Use opportunities to teach and learning as facets of professional practice.
Teaching and learning in human service practice
Learners in human service practice
Member of the public
Teachable moments: finding teaching opportunities
Developmental learning opportunities (e.g., common life tasks, role transitions)
Select appropriate resources and activities to support teaching.
Developing and using learning activities
Learning resources and materials
Printed learning resources
Slides and audiotapes
Use evaluation and feedback to measure and enhance teaching effectiveness.
Facilitate the transfer of learning.
Types of transfer
Factors affecting transfer
Context and degree of original learning
Similarity of the situation in which something is learned and the situation in which it is to be transferred
Relative advantage (extent that new behavior is seen as better than old)
Compatibility with existing practices, needs, and experiences
Complexity of new behavior
Trialability of new behavior (extent to which new behavior can be experimented with)
Observability of new behavior (extent to which positive outcomes are visible to others)
Increasing the probably of transfer
Working with intact social system within which learners will use new knowledge/skills
Promote conceptual learning, or higher level learning, rather than informational learning
Memory, retention, and learning
How memory forms
Stages and types of memory
Factors affecting retention of learning
Learning motor skills
Affect of daily biological rhythms on learning and memory
Intelligence and retrieval
Overview for the Professionalism Curriculum
The mercurial concept of medical professionalism is embedded in the principle that health care givers have an unwritten contract with society to behave and perform in an expected manner. These expectations are centered on relationships with patients, peers, community, the healthcare system, self, and the profession. Healthcare education literature defines professionalism in terms of the following constructs: humanism, reliability and responsibility; honesty and integrity; maturity; respect for others’ critique; altruism; duty; caring and compassion; excellence and scholarship; leadership; interpersonal and communication skills; absence of impairment; self improvement; adaptability; accountability; autonomy and self-regulation; conflict management; and knowledge.
Instruction and assessment of professionalism come in many forms, including direct classroom instruction, behavior observation and modeling, simulation, and self-reflection and journaling. Delivery of instruction should be guided by defined behaviors that can be documented instead of by value concepts that are abstract in nature. Professionalism instruction is delivered primarily through clinical observation and adoption of behaviors demonstrated by mentors in a clinical environment.
Professionalism Curriculum Content
Demonstrate calm, compassionate, helpful demeanor toward those in need.
Identify forms of help.
Forms of help
Treat others with dignity and respect, demonstrating sensitivity and responsiveness to culture, age, gender, and disability.
Discuss how diversity issues, health literacy or disparity issues might impact patient care and adherence to treatment.
Consistently strive for excellence in professional activities.
Be meticulous and careful in conducting professional tasks.
Work systematically and complete assignments in a timely manner.
Take responsibility for continuity of care.
Recognize how NMAA patient care and professional practices might affect other health care professionals and the health care organization.
Demonstrate ability to reflect on methods of improving professional behavior.
Act with integrity and understand personal limitations.
Refrain from performing tasks beyond personal capabilities or outside of professional scope of practice.
Accept responsibility for mistakes and report mistakes as appropriate.
Accept criticism and make an effort to improve.
Reflect on difficult encounters and analyze how values, skills, and knowledge are affecting care of patients with challenging and/or terminal illnesses.
Recognize and appropriately respond to impairment of self or colleagues.
Demonstrate the professional attitudes that must be considered by the NMAA.
Uphold the goals of the profession by supporting professional organizations, keeping professional confidences, maintaining competency, and exhibiting a professional image.
Definition of profession
Upholding goals of profession
Support of professional organization
Keeping professional confidences
Exhibit exemplary professional appearance and personal hygiene.
Adhere to the scope of practice and standards of practice, including the role of state and federal regulations.
Scope of practice
As defined by profession
State regulations and restrictions
Job descriptions (institutional scope of practice)
Demonstrate conscientiousness and organization in addressing all professional obligations.
Achieving and maintaining appropriate credentials
Foster professional relationships with members of the health care team.
Mentor students, technologists, and other members of the health care team.
Enhance the professional relationship by keeping the patient as the main focus.
Manage conflict among health professionals in a constructive manner.
Demonstrate accountability to the health care organization and society by adhering to ethical business principles.
Outline the nature of the special fiduciary relationship between the practitioner and the patient.
Demonstrate a commitment to medico-legal and ethical principles.
Apply the ethical principles of autonomy, non-malfeasance, beneficence, justice, paternalism, fidelity, veracity, altruism, integrity, respect, and compassion.
Practice patient-centered care that encompasses confidentiality, respect, and autonomy via appropriate informed consent and shared decision making.
Overview for the Systems-based Practice Curriculum
A systems-based practice view is critical to understanding patient outcomes, safety, values and quality. The NMAA must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. An interdisciplinary approach to understanding the structure, governance, financing and operation of health care systems will provide the NMAA with skills that will maximize patient care and increase health care efficacy. Systems-based practice competencies will be achieved by both didactic and clinical programmatic participation.
The NMAA must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. They will act as a patient advocate and assist patients in dealing with system complexities. The NMAA will be responsible for ensuring compliance with all local, state, regional and federal requirements as applicable. They will be instrumental in securing and maintaining accreditation status for nuclear medicine laboratories. Knowledge of coding practices and procedures will assure optimal and legal reimbursement. They will participate in strategic planning and budgetary decision making within the clinical setting. Competencies in clinical management will provide graduates of the NMAA program with skills to assist the department managers in daily operations that are relevant to clinical practice.
Systems-based Practice Curriculum Content
Describe the structure, governance, financing and operation of the health care system and its facilities and how this influences patient care, research and educational activities at a local, state, regional and national level.
Understand the structure and function of health care delivery systems and medical practices.
Evolution of health care system in the United States
Health care development to the 21st century
Developing role of government
Health care delivery systems
Ownership and system affiliation
Levels of care provided
Administrative structure and governance
Mission and vision
Other delivery systems
Emergency medical clinics
Home health care
Nursing home and extended care facilities
Describe the various third-party payer systems, covered health benefits, formularies, preauthorization, appeals, disease management and quality improvement.
Factors affecting economics of health care
Entitlement to access
Consumer expectations and demands
Cost of development
Cost of use
Shift from retrospective to prospective system
Shift from non-profit to profit based systems
Shift from fee-for-service to diagnostic related groups (DRGs) and capitation
Effects of federal and state regulations
Insured versus uninsured
Expense of chronic diseases
Supply and demand
Regional differences in availability and use of services
Fraud and abuse
Health care delivery and insurance systems
Retrospective fee-for-service system
Medicare and Medicaid
Development of DRGs
Effects of DRGs on other payer plans
Common Procedural Terminology (CPT), Ambulatory Payment Codes (APC), and International Classification of Diseases, Ninth Revision (ICD-9) codes
Managed care systems
Health maintenance organization (HMO)
How costs are controlled
Impact on health care costs
Preferred providers organization (PPO)
Physician-hospital organization (PHO)
Define and describe a patient population.
Cultural and socioeconomic conditions
Circumstances of living
Practice cost effective healthcare and resource allocation that do not compromise quality of care.
Review and adjust coding practices and procedures to assure optimal and legal reimbursement.
Laws and regulations pertaining to reimbursement.
Codes for services or exams rendered
Reimbursement maximization for services provided.
Support documentation for reimbursement for services
Analyze departmental budget, cost/revenue for optimal efficiency.