Training a Better Radiologist

Radiology Undergraduate and Resident Curricula: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine the literature regarding radiology curricula for both undergraduates and residents.

METHODS

A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references.

RESULTS

Of the 4716 unique abstracts reviewed by the author, 142 were found to be relevant to the purpose of this study. Undergraduate radiology education, radiology curriculum, and radiology pedagogy vary widely between disciplines and between colleges within disciplines. Formal radiology education is not taught at all medical programs and little radiology training is incorporated into non-radiology residencies. This results in some medical graduates not being taught how to interpret basic radiology images and not learning contraindications and indications for ordering diagnostic imaging tests. There are no definitive studies examining how to incorporate radiology into the curriculum, how to teach radiology to either undergraduates or residents, or how to assess this clinical competency.

CONCLUSIONS

This review shows that radiology education is perceived to be important in undergraduate and residency programs. However, some programs do not include radiology training, thus graduates from those programs do not learn radiology essentials.

Differences in neuroradiology training programs around the world

BACKGROUND AND PURPOSE

No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites.

MATERIALS AND METHODS

Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies.

RESULTS

While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%).

CONCLUSIONS

There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally.

Academic radiology in the new health care delivery environment

RATIONALE AND OBJECTIVES

Ongoing concerns over the rising cost of health care are driving large-scale changes in the way that health care is practiced and reimbursed in the United States.

MATERIALS AND METHODS

To effectively implement and thrive within this new health care delivery environment, academic medical institutions will need to modify financial and business models and adapt institutional cultures. In this article, we review the expected features of the new health care environment from the perspective of academic radiology departments.

CONCLUSIONS

Our review will include background on accountable care organizations, identify challenges associated with the new managed care model, and outline key strategies-including expanding the use of existing information technology infrastructure, promoting continued medical innovation, balancing academic research with clinical care, and exploring new roles for radiologists in efficient patient management-that will ensure continued success for academic radiology.

Imaging opportunities in radiation oncology

Interdisciplinary efforts may significantly affect the way that clinical knowledge and scientific research related to imaging impact the field of Radiation Oncology. This report summarizes the findings of an intersociety workshop held in October 2008, with the express purpose of exploring "Imaging Opportunities in Radiation Oncology." Participants from the American Society for Radiation Oncology (ASTRO), National Institutes of Health (NIH), Radiological Society of North America (RSNA), American Association of physicists in Medicine (AAPM), American Board of Radiology (ABR), Radiation Therapy Oncology Group (RTOG), European Society for Therapeutic Radiology and Oncology (ESTRO), and Society of Nuclear Medicine (SNM) discussed areas of education, clinical practice, and research that bridge disciplines and potentially would lead to improved clinical practice. Findings from this workshop include recommendations for cross-training opportunities within the allowed structured of Radiology and Radiation Oncology residency programs, expanded representation of ASTRO in imaging related multidisciplinary groups (and reciprocal representation within ASTRO committees), increased attention to imaging validation and credentialing for clinical trials (e.g., through the American College of Radiology Imaging Network (ACRIN)), and building ties through collaborative research as well as smaller joint workshops and symposia.

ACR white paper: task force on timing of oral boards in diagnostic radiology

The direction that the American Board of Radiology intends to follow relative to the diagnostic radiology oral board examination has risen quickly up the list of fundamental challenges for the radiology community. The formation of an ACR task force to study these changes was necessary, because this issue carries a high stake for the future of the profession and the patients we serve. After a careful review of the potential impacts, the committee discovered that consensus would be difficult to achieve relative to the merits of these changes. Accordingly, this white paper is focused objectively on the potential impacts on radiologists, practices, academic institutions, the ACR itself, and the ACR's membership. It is suggested that these concepts be used as starting points for future discussion and consideration of potential action.

Diagnostic radiologists' subspecialization and the new final board examination

OBJECTIVE

Recognizing that subspecialization can consist of concentration in multiple fields as well as in a single main field, we conducted this study to profile in detail the subspecialization of diagnostic radiologists in the United States in ways that illuminate issues related to the American Board of Radiology plan for a new final examination.

MATERIALS AND METHODS

We tabulated nonindividually identified data from the American College of Radiology 2003 Survey of Radiologists, a stratified random-sample mail survey with 1,924 responses and a 63% response rate. Respondents were guaranteed confidentiality. Responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Sixty-nine percent of respondents reported specializing at least to a small extent. If concentration in a field is defined as spending 10% or more of clinical work time in the field, 51% of radiologists concentrated in one or two fields, 24% in three or four fields, and 21% in more than four fields. An examination covering a radiologist's four most time-intensive fields would cover 80% of the clinical work of the median radiologist. However, the one fourth of radiologists whose work is most varied would have 40% or more not covered by the examination, but the one fourth with the most concentrated work would have 100% covered.

CONCLUSION

Most radiologists concentrate in a few fields, making the American Board of Radiology plan for an examination that covers four fields--or fewer, at an examinee's discretion--a major step forward in recognizing the nature of current practice. Four fields, however, are too many for the practice patterns of many radiologists but too few for the practice patterns of a substantial minority. We offer for consideration more far-reaching reforms.

Turf Wars in Radiology: What Must Academic Radiology Do?

In a previous article in this series, the authors called on private practice radiology groups to better support radiology research financially but also pointed out that academic radiology must make some changes as well. In this article, the authors discuss those changes in detail. They include revising the structure of the radiology residency, changing the timing of the American Board of Radiology oral examinations, requiring that all residents receive research training, and emphasizing the value of clinical and translational research. The Society of Chairmen of Academic Radiology Departments needs to assume a leadership role in implementing these changes.