Having attended the annual Association of University Radiologists (AUR) meeting and other society meetings in diagnostic radiology this past Spring, I am left with a feeling that all is not uniform in the views toward recent changes in radiology in training. Indeed, Mullins and Gunderman expressed many of these sentiments in recent months , and similar uneasiness was shared in the recently published surveys of the Association of Program Directors in Radiology (APDR) . Such surveys suggested concerns over the new Interventional Radiology/Diagnostic Radiology (IR/DR) pathway and continued to emphasize the problems of “board frenzy” and “fellowship frenzy.” Anxiety regarding the new problem of post-Core “senioritis” dominated discussions at the 2014 and 2015 annual AUR meetings.
In the meanwhile, despite continuing to match applicants who perform well on the United States Medical Licensing Examination (USMLE) , Diagnostic Radiology lingers as one of the medical specialties with lower fill rates in the match . Given the requirement for Accrediation Council for Graduate Medical Education (ACGME)-accredited postgraduate year 1 (PGY-1) training, I dread that the new limiting factor will become the number of Supplemental Offer and Acceptance Program (SOAP)-available applicants who can secure PGY-1 training.
IR/DR residency pathways of 6 and 7 postgraduate training years been approved for implementation by the ACGME . Although it does worry me that establishing any residency of such a length may impede medical student interest further in an era of increasing student loan debt, I do appreciate the need for interventionalists to establish themselves as autonomous clinical practitioners while possibly recovering additional GME residency funding in the PGY-6 years for the integrated pathway . In the face of so much opposition, particularly from programs without interventional radiology fellowships and from diagnostic subspecialists, I postulate that there is a simpler path to achieve the same goal. The new IR/DR tract just has so many variations and accommodations that practicing radiologists can hardly understand them, let alone applying medical students.
Change is not unique to interventional radiology. The American Board of Radiology (ABR) has endorsed Nuclear Radiology certification within the Diagnostic Radiology residency. Neuroradiology fellowships routinely encourage a second year. Multiple opportunities exist for pediatric radiologists to participate in a second year of more specialized training. All of these subspecialties recognized by the ABR already operate under ACGME accreditation.
Despite recognizing the value that having a dedicated clinical year offers, radiology lags well behind anesthesiology in its ability to integrate and capitalize on this clinical training. When will all of radiology—not just interventional radiology—redefine itself as a profession of clinicians itself? Though integration of the PGY-1 clinical year into Diagnostic Radiology training has not yet become commonplace, I do feel as though this will become requisite of us in the future if we seek to legitimize diagnostic radiology as a value-oriented clinical specialty. This would simplify and streamline the application process, bring trainees into radiology didactics earlier, stimulate milestone development in the PGY-1 year, allow radiology departments to recover graduate medical education funding at the start of training, better standardize the clinical skill set of the radiologist, pull even with most other specialties that have evolved away from the isolated intern year, avoid the problem of PGY-1 position shortages, and make more efficient use of the condensed curriculum that has been established.
I also propose that Diagnostic Radiology subspecialties should consider the route of Child and Adolescent Psychiatry which utilizes the final year of psychiatry residency to begin fellowship instead of developing a longer residency program. This would allow the resident to remain within the confines of an ACGME-regulated environment over the course of the 4 years of radiology training deemed necessary by the ABR.
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References
1. Mullins M.E., Gunderman R.B.: Change overload and the program director. Acad Radiol 2015 Apr; 22: pp. 539-540.
2. Rozenshtein A., Mullins M.E., Deitte L.A., et. al.: “What Program Directors Think” II: Results of the 2013 and 2014 Annual Surveys of the Association of Program Directors in Radiology. Acad Radiol 2015 Jun; 22: pp. 787-793.
3. National Resident Matching Program. Charting outcomes in the match. http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf . Accessed May 22, 2015.
4. National Resident Matching Program. Advance data tables. http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf . Accessed May 22, 2015.
5. LaBerge J.M., Anderson J.C.: A guide to the interventional radiology residency program requirements. J Am Coll Radiol 2015;
6. Marx M.V., Sabri S.: IR residency. Steps to implementation. J Am Coll Radiol 2015;
7. Fox, G. Why child and adolescent psychiatry? https://www.aacap.org/AACAP/Medical_Students_and_Residents/Medical_Students/Why_Child_and_Adolescent_Psychiatry.aspx#nine . Accessed May 22, 2015.
8. Jackson, V. A message from the ABR Executive Director. Annual Report 2013-2014, Annual Board of Radiology, pg. 4.