Expanded competencies for the nuclear medicine advanced associate (nmaa) introduction

Maintain appropriate protocol, courtesy, tact, and confidentiality in business communication, both written and oral

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Maintain appropriate protocol, courtesy, tact, and confidentiality in business communication, both written and oral.

    1. Email

    2. Correspondence: letters and memos

    3. Phone conversations

    4. Netiquette

  1. Demonstrate an appropriate level of communication skills when orally presenting professional or scholarly work.

    1. Grand Rounds

    2. Presenting lectures/seminars/conferences/posters

  1. Demonstrate technical writing ability in a variety of venues, including scholarly writing and business communications.

    1. Write an abstract according to published standards.

    2. Prepare a poster for presentation at a professional conference.

    3. Write scholarly articles.

    4. Develop patient procedure protocols.

    5. Develop department policies.

    6. Write business correspondence such as business letters, memos, or internal reports.

    7. Prepare reports, such as a needs assessment or progress report.

    8. Develop action plans for quality improvement projects.

    9. Develop patient education materials.

  1. 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.

    1. Use the evidence-based medicine (EBM) process of asking, acquiring, appraising, applying, and assessing to improve clinical practice.

      1. The EBM process

        1. Asking

        2. Acquiring

        3. Appraising

        4. Applying

        5. Assessing

      1. The patient

        1. Start with the patient

        2. A clinical problem or question arises out of the care of the patient

      1. The question: construct a well built clinical question derived from the case

        1. 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.)

        2. Prioritizing competing clinical questions

      1. The resource: select the appropriate resource(s) and conduct search

        1. Types of scientific evidence

          • Animal research/laboratory studies

          • Case series/case reports
          • Case control studies

          • Cohort studies

          • Randomized controlled trial

          • Systematic review

          • Meta-analysis

        2. Expert opinion

      1. The evaluation: appraise the evidence for its validity and applicability

      2. The patient: return to the patient

        1. Integrate evidence with clinical expertise and patient preferences

        2. Apply it to practice

      1. Self-evaluation: evaluate performance with this patient

    1. Analyze practice organization and management and perform practice based improvement activities.

      1. Clinical practice evaluation

        1. Practice demographics

          • Patient demographics

          • Organization demographics

            1. Location

            2. Number of exams performed per year

            3. Number of full-time employees working in department

            4. Regulatory and accreditation agencies

        1. 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?)

        2. Clinical performance
          • The performance gap: desired - actual performance

            1. Mission, goals, and vision

            2. Expectations

            3. Strategic planning and forecasting

          • Methods of evaluation

            1. Indirect

              1. Surveys/ratings

              2. Review of records (audits)

            2. Direct

              1. Observation of real encounters

              2. Observation of simulated encounters

          • Criteria for performance measures

            1. Relevance

            2. Understandable

            3. Measurable

            4. Formulated in behavioral (observable) terms

            5. Acceptable

          • Problem-prone departmental performance indicators

            1. Sentinel events

              1. Patient misidentification events

              2. Failure to assess pregnancy status

              3. Failures to recognize and/or respond to changes in patient condition

              4. Medication variances/adverse drug reactions

              5. Infection control

              6. Patient falls and other accidental injury

            2. Routine events

              1. Obtaining accurate medical history

                1. Effective chart review

                2. Effective patient interview

                3. Effective referring physician interview/follow-up

                4. Effective and complete physical examination (including mental)

              2. Documentation - completeness/accuracy/errors

              3. Patient compliance with preparation guidelines

              4. Patient complaints

              5. Patient follow-up

          • Diagnostic accuracy

            1. Reading films (false positive/false negative rates)

            2. Accuracy and completeness of reports
          • Patient-centered outcomes

            1. Functional health status

            2. Quality of life

            3. Satisfaction

          • Radiation exposure

            1. Patients

            2. Staff

          • Individual staff performance and development (360 degree evaluation, report cards)

            1. Adherence to job description

            2. Attitude

            3. Knowledge and skills

            4. Productivity; cost-effectiveness of practice; quality of care

            5. Accountability

            6. Communication skills

            7. Cooperation/teamwork

          • Staff Utilization and development

      1. Practice organization and management

        1. Patient medical records (including images and graphics)

        2. Reporting

          • Transcription time

          • Signature time

          • Turnaround time

        3. Scheduling (patient procedures, staffing)

        4. Charge capture and checkout

        5. Medical claims management (coding/reimbursement)

        6. Medical billing & collections

        7. Financial accounting indicators

          • Expenses

          • Days in accounts receivable

          • Cost per relative value unit (RVU)

          • Average RVU per examination

          • Hours worked per RVU

          • Collections by examination

          • Supply cost per RVU

        8. Productivity indicators

          • Examination volume

          • RVUs per FTE employee

          • Gross charges by examination

          • Collections by FTE employee

          • Volume by device

      1. Technology assessment

        1. Equipment utilization and patient access

        2. Quality control programs

        3. Maintenance and replacement schedules

    1. Develop a personal program of self-study and professional growth.

  • Use benchmarking analysis and adjust processes, procedures and operations for comparison with published standards of care.

    1. Follow a systematic process for identifying and implementing best or better practices.

    1. Follow professional standards of practice and work within the NMAA scope of practice to improve patient care and safety and protect the public.

      1. Scope of Practice

        1. Definition

          • Procedures, actions, and processes permitted for licensed individual

          • Description of what can and cannot be done by licensed individual

            1. Establishes which activities and procedures represent illegal activity if performed without licensure

            2. Includes technical skills that, if done improperly, represent a significant hazard to the patient and therefore must be kept out of the hands of the untrained.

        2. Purpose

          • Health care goals

            1. Improve patient care

            2. Ensure patient safety

            3. Protect the public

          • Legislative goals

            1. Establishes legislation, rules, and regulations
            2. Establishes boundaries between professionals and lay persons

            3. Establishes boundaries among different licensed health care professionals

              1. Creates exclusive domains of practice

              2. Creates overlapping domains of practice.

          • Components

            1. Education

            2. Certification

            3. Licensure

            4. Credentialing

        3. Source of authority

          • Authority vested by State

          • Defined in law, regulations, or policy documents

          • Establishes Licensing or governing boards

        4. National or federal considerations in establishing professional guidelines

          • Improves consistency among States’ scopes of practice

          • Facilitates reciprocity or portability

          • Improves professional mobility

          • Promotes consistency of personnel titles

          • Improves the name recognition and public understanding of role of NMAA

          • Establishes standardized curriculum

        5. Education component

          • Establishes appropriate education, clinical experience, and competencies

            1. Specifies education program accreditation requirements

            2. Outlines cognitive, psychomotor and affective learning requirements

          • Establishes entry level, advanced level, and mandatory continuing or additional training, practice, or education

        6. Certification component

          • Certification examinations

          • Other demonstrations of competency

        7. Licensure component

          • Permission granted to an individual by the State to perform certain restricted activities

          • Outlines requirements for maintenance of licensure

        8. Credentialing component

          • Definition
            1. Local process by which an individual is permitted by a specific entity (Medial Director) to practice in a specific setting

            2. Varies in sophistication and formality

          • Facility policy: establishes rights and responsibilities within the hospital or healthcare setting

          • Physician delegation: establishes oversight responsibility (e.g., medical direction)

        9. Ethical and legal considerations of licensee

          • Patient and client needs are uppermost

          • Keep up-to-date and continue to develop knowledge, skills and competence

          • Recognize limits to personal knowledge and skill and remedy deficiencies

          • Acknowledge personal accountability

          • Avoid inappropriate delegation

        10. Other variables in scope of practice issues

          • Employer

          • Professional associations

          • Collaborating physician

          • Nurse practice act

          • Medicare provider

          • Insurance carrier

        11. Special considerations

          • Scope of practice variations for special populations

            1. Pediatric

            2. Geriatric

            3. Patients with disabilities

            4. Patients with limited access to health care for geographic, demographic, socioeconomic, or other reasons

          • Scope of practice variations for specialized practice settings

            1. Cardiology

            2. Oncology

            3. Pediatrics

          • Scope of practice variations in non-traditional roles

          • Scope of practice variations during disasters or public health emergencies

        12. Comparisons between NMAA and NMT scopes of practice

          • Skills

          • Practice environment

          • Knowledge

          • Qualifications

          • Services provided

          • Risk
          • Level of supervisory responsibility

          • Amount of autonomy

          • Judgment/critical thinking/decision making

      1. Standards of Practice

        1. Description

          • 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

        2. 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

        3. 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.

    1. Identify and assess the relevance of and utilize credible sources of information.

      1. Scientific literature

        1. Critically evaluate studies and research to determine the appropriateness of the type of research done and its relative validity

        2. Reflect on the merits of descriptive vs. explanatory approaches given a specific context and/or construct

        3. Select the most appropriate research methodology

        4. meta-analysis

        5. longitudinal

        6. random double-blind

        1. retrospective

        2. cross-section

      1. Sources of information that patients may commonly access in literature or online

    1. 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.

    1. 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.

      1. Determine whether the research will be best undertaken at a formal or informal level taking into consideration several factors

        1. Significance or severity of problem

        2. Cost of not responding

        3. Universality of problem

        4. Generalizability of the proposed solution or findings

        5. Scope of problem

        6. Available resources

          • Human

          • Fiscal

          • Temporal

          • Experiential

      2. Identify and clarify the research question reflecting on the optimal approaches

        1. Rank order and prioritize the key issues

        2. Gather and sort data

        3. Seek feedback and agreement with key stakeholders
        4. Pilot test any instruments designed to gather data and analyze the feedback to critically assess effectiveness

      3. Identify the population to be studied

      4. Determine the best approach to sample that population

      5. Select the study sample after carefully considering the following factors

        1. Population and sample

          • Random or intentional

          • Cohort or stratified

        2. How should the study sample be characterized?

        3. Reflect on the appropriate sample size after analyzing the demographics of the population and focus of the study

        4. Based on the study’s purpose critically evaluate each of the possible methods for identifying and selecting sample members

          • Random

          • Intentional

          • Convenience

      6. Determine whether to use a Quantitative and/or a Qualitative research approach after considering the following factors

        1. Resource availability

          • Human

          • Fiscal

          • Temporal

          • Experiential

        2. Extent to which the study is seeking to build on extant knowledge or investigate new concepts and territory

        3. Degree to which the methodology is congruent with the research question, topic or problem

      7. Contemplate and consider what other types of research might be helpful

      8. Create a clear, comprehensive and workable hypothesis and based on that include the following actions, findings and safeguards.

        1. Decide whether the study should utilize participants or subjects

        2. Ensure that issues of ethics and approval have been adequately addressed

        3. Complete a critical analysis of the literature and disseminate the findings as appropriate citing representative sources
        4. Address issues of potential bias in the study sample to ensure that the study’s findings and conclusions results have high validity

        5. Ensure maximum study trustworthiness by monitoring the study and its design, implementation and analysis on an ongoing basis

        6. If using a qualitative approach contemplate, propose and utilize multiple alternative approaches to assess and assure study validity

        7. 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

        8. 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

            1. Variables and measurement scales

            2. Populations and Samples

              1. Methods of Sampling

              2. Sample Bias

              3. Sample Size

          • Descriptive Statistics

        9. Organizing and Grouping Data

            1. Measure of Central Tendency (e.g., mean, median, mode)

            2. Measures of Variability (e.g., standard deviation, variance)

          • Measuring Relationships

            1. Correlation

            2. Prediction and Regression

          • Inferential Statistics

            1. t-test

            2. Analysis of Variance

            3. Chi-square

          • Interpretation and Use

            1. Reliability

            2. Validity

            3. Measurement Error
        10. 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.

    1. 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.

    1. Utilize these data and their analysis to educate peers and disseminate findings.

    1. 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.

    1. 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.

    1. 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.

    1. Use current information technology and other sources to efficiently locate and retrieve relevant information from credible sources.

    1. Follow ethical principles in using information that may be sensitive.

    1. 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.

    1. Use opportunities to teach and learning as facets of professional practice.

      1. Teaching and learning in human service practice

        1. formal

        2. informal

      2. Learners in human service practice

        1. Individuals

          • Patients

          • Students

          • Colleagues

          • Other professionals

          • Other clients

          • Member of the public

        2. Small groups

        3. Communities

        4. Professional groups

      3. Teachable moments: finding teaching opportunities

        1. Developmental learning opportunities (e.g., common life tasks, role transitions)

        2. Critical learning opportunities (e.g., unexpected crisis)

      4. Foundations of teaching in human service practice

        1. Patient education

        2. Health promotion

        3. Community education and development

        4. Professional education

    1. Develop learning relationships with clients, patients, students and colleagues.

      1. Viewing patients/clients as learners
        1. Teaching philosophies

          • Positivism

          • Constructivism

          • Stages of Learning

            1. Dualism

            2. Multiplicity

            3. Contextual relativism

        2. Styles of learning

          • Concrete-to-abstract

          • Active-to-reflective

        3. Principles of effective teaching

          • Based on the learner's self-concept

            1. Self-image and self-esteem

            2. Need for respect and partnership

          • Based on the learner's life experience

            1. Level and context for learning

            2. Grafting: understanding the new in terms of the old

            3. Enriched communication

            4. Sharing learning

          • Based on the learner's purpose for learning

        1. The resource: select the appropriate resource(s) and conduct search

          • Types of scientific evidence

            1. Animal research/laboratory studies

            2. case series/case reports

            3. case control studies

            4. cohort studies

            5. randomized controlled trial

            6. systematic review

            7. meta-analysis

          • Expert opinion

        1. The evaluation: appraise the evidence for its validity and applicability

        2. The patient

          • Return to the patient

          • Integrate evidence with clinical expertise and patient preferences

          • Apply to practice

        3. Self-evaluation: evaluate performance with this patient

      1. Developing learning relationships with clients, patients, students and colleagues

        1. Empowerment

        2. Critical reflection

        3. Self-directed learning

        4. Situational teaching and the teaching-to-facilitating continuum

          • Telling

          • Instructing

          • Participating

          • Delegating

        5. Attribute of effective teachers and facilitators

          • Interpersonal skills

          • Expertise

          • Empathy

          • Enthusiasm

          • Clarity and organizational skills

        6. Sources of influence

          • Coercive influence

          • Reward influence

          • Legitimate influence (role-related influence)

          • Referent influence (based on admiration or personal identification)

          • Expert influence

        7. Building Credibility

          • Maintenance credibility

          • Organizational credibility

          • Change agent credibility

    1. Assess what needs to be learned and demonstrate effective teaching techniques in settings that may be spontaneous or by design.

      1. Assessing what needs to be learned

        1. Pre-formative assessment

        2. Who identifies learners and learning needs?

        3. Who perceives the need?

        4. Assessment strategies

          • Interviews

          • Questionnaires

          • Focus groups

          • Emergent assessment (from shared experience)

          • Embedded assessment

        1. Learning objectives

          • Objective clarification
          • Objective classification

            1. Cognitive domain

            2. Psychomotor domain

            3. Affective domain

          • Elements of well-stated learning objectives

            1. Who?

            2. Will do what?

            3. Under what conditions?

            4. To what level?

          • Advantages and limitations of performance-based objectives

        2. Asking Questions

          • Levels and types of questions

            1. Exploratory

            2. Challenge

            3. Relational

            4. Diagnostic

            5. Action

            6. Cause-and-effect

            7. Extension

            8. Hypothetical

            9. Priority

            10. Summary

          • Tactics for effective questioning

            1. Ask one question at a time

            2. Avoid yes/no questions

            3. Ask focused questions

            4. After you ask a question, wait silently for answer

            5. Ask questions that require learner to demonstrate understanding

            6. Draw out reserved or reluctant learners

            7. Use questions to change the tempo or direction of discussion

            8. Use probing strategies

          • Tactics for handling responses

            1. Actively listen

            2. Use non-verbal gestures to indicate your attention

            3. Vary your reaction to students' answers

            4. Tactfully correct inaccuracies

            5. Ask questions that require learner to demonstrate understanding

            6. Draw out reserved or reluctant learners

            7. Use questions to change the tempo or direction of discussion

            8. Use probing strategies
      1. Teaching effectively – spontaneously and by design

        1. Selecting a delivery method

          • Face-to-face teaching

          • Person-mediated distance education (e.g., conference calls)

          • Program-mediated interactive distance education (e.g., CD-rom, Internet)

          • Non-interactive distance education (e.g., printed materials)

        1. Sequencing learning activities

          • Simple to complex

          • Established sequence

          • Historical sequence

          • Most important to least important

          • Most familiar to least familiar

          • General to specific

          • Concrete to abstract

        2. Planning a teaching episode (using EDICT)

          • Explain

          • Demonstrate

          • Involve

          • Coach

          • Test/terminate/transfer

    1. Select appropriate resources and activities to support teaching.

  1. Developing and using learning activities

        1. Icebreakers

        2. Role-playing

        3. Case studies

        4. Simulations

        5. Mind mapping

        6. Values clarification

        7. Problem-solving activities

        8. Visioning exercises

        9. Brainstorming

        10. Decision/value matrices

  1. Learning resources and materials

        1. Printed learning resources

        2. Flip-charts

        3. Audiovisual materials

          • Videotape

          • Slides and audiotapes

          • Computer-assisted instruction

          • Multimedia

        4. Simulations

        5. Mind mapping

        6. Values clarification

        7. Problem-solving activities

        8. Visioning exercises

        9. Brainstorming

        10. Decision/value matrices

    1. Use evaluation and feedback to measure and enhance teaching effectiveness.

      1. Per-formative evaluation

      2. Formative evaluation

      3. Summative evaluation

    1. Facilitate the transfer of learning.

      1. Types of transfer

        1. Positive

        2. Negative

      1. Factors affecting transfer

        1. Context and degree of original learning

        2. Similarity of the situation in which something is learned and the situation in which it is to be transferred

        3. Relative advantage (extent that new behavior is seen as better than old)

        4. Compatibility with existing practices, needs, and experiences

        5. Complexity of new behavior

        6. Trialability of new behavior (extent to which new behavior can be experimented with)

        7. Observability of new behavior (extent to which positive outcomes are visible to others)

      2. Increasing the probably of transfer

        1. Working with intact social system within which learners will use new knowledge/skills

        2. Promote conceptual learning, or higher level learning, rather than informational learning

        3. Follow-up teaching

          • Fine-tuning

          • Trouble-shooting

      3. Memory, retention, and learning

        1. How memory forms

        2. Stages and types of memory

        3. Factors affecting retention of learning

        4. Learning motor skills
        5. Affect of daily biological rhythms on learning and memory

        6. 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

  1. Demonstrate calm, compassionate, helpful demeanor toward those in need.

    1. Identify forms of help.

      1. Forms of help
        1. Philanthropic

        2. Work Related

        3. Solicited

      2. Sharing workload

        1. Unsolicited

        2. Fulfilling need

  1. Treat others with dignity and respect, demonstrating sensitivity and responsiveness to culture, age, gender, and disability.

    1. Discuss how diversity issues, health literacy or disparity issues might impact patient care and adherence to treatment.

  1. Consistently strive for excellence in professional activities.

    1. Be meticulous and careful in conducting professional tasks.

    1. Work systematically and complete assignments in a timely manner.

    1. Take responsibility for continuity of care.

    1. Recognize how NMAA patient care and professional practices might affect other health care professionals and the health care organization.

    1. Demonstrate ability to reflect on methods of improving professional behavior.

  1. Act with integrity and understand personal limitations.

    1. Refrain from performing tasks beyond personal capabilities or outside of professional scope of practice.

    1. Accept responsibility for mistakes and report mistakes as appropriate.

    1. Accept criticism and make an effort to improve.

    1. Reflect on difficult encounters and analyze how values, skills, and knowledge are affecting care of patients with challenging and/or terminal illnesses.

    1. Recognize and appropriately respond to impairment of self or colleagues.

      1. Personal Health

      2. Stress management

      3. Healthy living

  1. Demonstrate the professional attitudes that must be considered by the NMAA.

    1. Uphold the goals of the profession by supporting professional organizations, keeping professional confidences, maintaining competency, and exhibiting a professional image.

      1. Definition of profession

        1. Professionalism

        2. Professional behavior

      2. Attitude

        1. Upholding goals of profession

        2. Support of professional organization

        3. Keeping professional confidences

        4. Maintaining competency

        5. Professional image

    1. Exhibit exemplary professional appearance and personal hygiene.

    1. Adhere to the scope of practice and standards of practice, including the role of state and federal regulations.

      1. Scope of practice
        1. As defined by profession

        2. State regulations and restrictions

        3. Job descriptions (institutional scope of practice)

      1. Updating skills

    1. Demonstrate conscientiousness and organization in addressing all professional obligations.

      1. Achieving and maintaining appropriate credentials

        1. Professional credentialing

        2. Institutional credentialing

      1. State licensure

      2. Continuing Ed

      3. Regulatory compliance

  1. Foster professional relationships with members of the health care team.

    1. Mentor students, technologists, and other members of the health care team.

    1. Enhance the professional relationship by keeping the patient as the main focus.

    1. Manage conflict among health professionals in a constructive manner.

  1. Demonstrate accountability to the health care organization and society by adhering to ethical business principles.

    1. Outline the nature of the special fiduciary relationship between the practitioner and the patient.

  1. Demonstrate a commitment to medico-legal and ethical principles.

    1. Apply the ethical principles of autonomy, non-malfeasance, beneficence, justice, paternalism, fidelity, veracity, altruism, integrity, respect, and compassion.

    1. 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

  1. 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.

    1. Understand the structure and function of health care delivery systems and medical practices.

      1. Evolution of health care system in the United States

        1. Health care development to the 21st century

        2. Developing role of government

      1. Health care delivery systems

        1. Classification

          • Ownership and system affiliation

          • Location

          • Levels of care provided

            1. Primary

            2. Secondary

            3. Tertiary

          • Teaching status

        2. Accreditation

        3. External influences

        4. Internal influences

        5. Administrative structure and governance

        6. Mission and vision

      1. Other delivery systems

        1. Outpatient clinics

        2. Emergency medical clinics

        3. Home health care

        4. Public health

        5. Mobile clinics

        6. Nursing home and extended care facilities

        7. Telemedicine

    1. Describe the various third-party payer systems, covered health benefits, formularies, preauthorization, appeals, disease management and quality improvement.

      1. Factors affecting economics of health care

        1. Entitlement to access

          • Consumer expectations and demands

          • Ethical aspects

        2. Technology

          • Improved care

          • Improved access

          • Cost of development

          • Cost of use

        3. Quality

          • Importance

          • Cost

        4. Legislation

          • Consumer protection

          • Cost containment

        5. Payer systems

          • 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

        6. Population

          • Insured versus uninsured

          • Age shift

          • Expense of chronic diseases

        7. Supply and demand

          • Regional differences in availability and use of services

          • Competition

        8. Fraud and abuse

      1. Health care delivery and insurance systems

        1. Retrospective fee-for-service system

        2. Medicare and Medicaid

          • CMS

          • Original configuration

          • 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

      1. Managed care systems

        1. Health maintenance organization (HMO)

          • Configuration

          • How costs are controlled

          • Impact on health care costs

          • Capitation

        2. Preferred providers organization (PPO)

        3. Physician-hospital organization (PHO)

    1. Define and describe a patient population.

      1. Patient demographics

      2. Cultural and socioeconomic conditions

      3. Circumstances of living

      4. Health status

      5. Epidemiological studies

  1. Practice cost effective healthcare and resource allocation that do not compromise quality of care.

    1. Review and adjust coding practices and procedures to assure optimal and legal reimbursement.

      1. Reimbursement methodologies

      2. Laws and regulations pertaining to reimbursement.

      3. Codes for services or exams rendered

      4. Reimbursement maximization for services provided.

      5. Support documentation for reimbursement for services

    1. Analyze departmental budget, cost/revenue for optimal efficiency.

      1. Understanding of accounting and finance practices

      2. Preparation of a departmental budget

      3. Assessment of appropriateness of expenditures

      4. Understanding capital equipment expenditures and depreciation

      5. Determination of staffing needs

      6. Projecting revenue and expenses

      7. Recognition of fixed and variable expenses

      8. Calculation of net income losses and gains

      9. Preparation of budgetary reports

      10. Aligning resources with expenses

    1. Provide documented analysis and data for resource acquisition.

      1. Modality appropriateness assessment

      2. Business plan development

      3. Cost benefit analysis

      4. Preparation of RFPs and RFIs

      5. RFPs and RFIs analysis

      6. Interpretation of regulatory information

      7. Interpretation of financial reports and data

      8. Justification of need

      9. Comparative analyses

    1. Follow filing and documentation practices for practitioner reimbursement as directed by CMS policies and procedures, state, and federal law.

      1. Maintenance of patient records

      2. CMS policies and procedures

      3. Documentation for services provided

      4. Documentation for physician reports

      5. Timely and accurate patient reporting

  1. Ensure compliance for all local, state, regional, and federal requirements for laboratory operations and personnel training and credentialing.

    1. Comply with current federal, regional and local regulations governing the laboratory.

      1. Health care professional credentialing

        1. Certification

        2. Licensure

        3. Registration

      1. Credentialing agencies

        1. National organizations

        2. State agencies

      1. Regulatory agencies

        1. Food and Drug Administration

        2. Nuclear Regulatory Commission

        3. Occupational Safety and Health Administration

        4. U.S. Department of Transportation

        5. State agencies

      1. Advisory agencies

        1. International Commission on Radiation Units and Measurement

        2. National Council on Radiation Protection and Measurement

        3. National Academy of Sciences Advisory Committee on the Biologic Effects of Ionizing Radiation

        4. United Nations Scientific Committee on the Effects of Atomic Radiation

    1. Conduct procedures and provide documentation for laboratory accreditation.

      1. Purpose of accreditation

        1. Quality of care

        2. Reimbursement

      1. Health care facility accreditation

        1. Governmental

        2. National

          • ICANL

          • ACR

        3. State

      1. Standards of accreditation

    1. Implement Joint Commission standards.

      1. The accreditation process

      2. Sentinel events

      3. National patient safety goals

      4. The Joint Commission quality report

      5. Accreditation participation requirements (APRs)

      6. Standards, rationales, elements of performance, and scoring

      1. Section 1: Patient-focused functions

        1. Ethics, fights, and responsibilities (RI)

        2. Provision of care, treatment, and services (PC)

        3. Medication management (MM)

        4. Surveillance, prevention, and control of infection (IC)

      2. Section 2: Organization functions

        1. Improving organization performance (PI)

      3. Leadership (LD)

      4. Management of the environment of care (EC)

      5. Management of human resources (HR)

      6. Management of information (IM)

      1. Section 3: Structures with functions

      1. Medical staff (MS)

      2. Nursing (NR)

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