Resident Clinical Ownership: From Task Executor to Clinically Accountable Radiologist

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Resident Clinical Ownership Framework

Resident Clinical Ownership

"From Task Executor to Clinically Accountable Radiologist"

Dr. Sharad Maheshwari
imagingsimplified@gmail.com
10.01.2026
Phase 1

Clinical Orientation

Before the scanner starts.

  • ✅ Name the disease: "Biopsy-proven adenocarcinoma" NOT "Prostate MRI".
  • ✅ Map the Journey: Suspected? Newly diagnosed? Surveillance?
  • ✅ Identify Modifiers: Surgery, RT, Chemo, Hormones.
Red Flag: If you can't state the disease phase out loud, you aren't ready to scan.
Phase 2

Question Ownership

What does the clinician *actually* need?

  • ✅ One primary question: Local staging? Recurrence? Progression?
  • ✅ Prediction: What do I expect to see? (e.g., Post-RT = low T2 signal).
Phases 3 & 4

Data & Planning

  • ✅ Prior Integration: Summary of findings in 2 sentences.
  • ✅ Defining Labs: PSA, CA-125, AFP, Creatinine.
  • ✅ Protocol Tailoring: Mentally justify why this modality/phase.
  • ✅ Anticipate Pitfalls: What can I overcall or miss?
Phases 5 & 6

Execution & Handover

  • ✅ Real-time Vigilance: Do images match expectations? Add sequences?
  • ✅ Structured Summary: "Patient is X years old with Y disease at Z stage..."
Phase 7

Learning Loop

"Did this study answer the clinical question?"

Continuous Reflection = Independence

Definition of Ownership

"The resident can defend why the study was done, how it was done, and what it means — without hiding behind the requisition form."

Resident Clinical Ownership Assessment Rubric (COAR)

Objectively score performance across 10 domains.

Domain Score (0-3)
0
Total Score / 30
Pending Assessment

Non-Negotiable Failures:

  • Unknown clinical question
  • Prior critical imaging not reviewed
  • Missed treatment history

Ownership Reality Check

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