We read with interest the perspective of Drs Gunderman and Tobben , and Dr Jackson on the value of clinical year in radiology residency. We wish to comment on this topic and suggest a new proposal that could be a solution for the concerns of both viewpoints.
As international medical graduates, we had an 18-month clinical internship at the end of 7.5 years of medical school in Iran. Although those months were tough in terms of workload and night shifts, in retrospect, we believe that the supervised independent patient management and encounter gave us the knowledge, skill, and confidence in practicing as physicians. Therefore, we strongly believe that all physicians, including diagnostic radiologists, need clinical internship.
The length of residency and a tough job market after graduation have been proposed as contributors to the decline in quantity and quality of diagnostic radiology residents in the United States . Although eliminating the clinical year to reduce the length of training can theoretically increase the attractiveness of radiology for medical students, it may eventually harm the whole medical community. With current emphasis on patients’ management and direct patient interactions, diagnostic radiologists need to be able to visit patients, communicate with clinicians, and be more involved in clinical practice. In the current design of medical schools curricula, independent clinical experience should be gained during internship year. Therefore, elimination of the internship may compromise clinical competence of a diagnostic radiologist.
The effectiveness of internship, especially transitional year in diagnostic radiology is not optimal . Radiology residency programs and the American Board of Radiology can take part in improving and unifying the standards of clinical competency through collaboration with clinical programs and the Accreditation Council for Graduate Medical Education. Most radiology programs are within well-resourced academic or community hospitals. They have the means to implement, monitor, and evaluate the clinical competence of their trainees. We recommend integrating clinical year into radiology residency within the same institution which can spare diagnostic radiology applicant’s anxiety, cost, travel time, and a possible relocation. The clinical year can be divided in 4 years of diagnostic radiology residency. We propose a 6-month initial encounter in different clinical specialties in Post-graduate year (PGY1) with emphasis on topics related to a radiologist. During PGY2 to PGY4, radiology residents can have rotations within clinical departments and play the role of radiology consultants for their clinical colleagues. This approach not only enhances the clinical experience for radiology residents, but also increases the visibility of radiologists to clinicians, hospital administrators, and patients.
The main obstacle for this approach would be the need of smaller community hospitals for those interns in their clinical operations. We believe that due to the national shortage in primary care physicians, those programs would benefit from recruiting residents for categorical programs in primary care instead of a 1-year preliminary internship. This would be a more sustainable solution for their programs and patients.
We are aware that changing the curriculum requires tremendous effort and planning in the administrative point of view. It would not be an easy solution, but we believe it can eventually benefit the radiology community as well as the clinicians and the patients.
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References
1. Gunderman R.B., Tobben J.P.: Is it time to jettison radiology’s clinical year requirement?. Acad Radiol 2016; 23: pp. 389-391.
2. Jackson V.P.: The clinical internship for radiology: is there value?. Acad Radiol 2016; 23: pp. 265-266.
3. Sharafinski M.E., Nussbaum D., Jha S.: Supply/demand in radiology: a historical perspective and comparison to other labor markets. Acad Radiol 2016; 23: pp. 245-251.
4. Baker S.R., Tilak G.S., Geannette C., et. al.: The value of the internship year for radiologists: a retrospective analysis as assessed by current residents and fellows. Acad Radiol 2008; 15: pp. 1205-1210.
5. Baker S.R., Tilak G.S., Thakur U.: Critique of the transitional year internship and its relationship to radiology residency. Acad Radiol 2008; 15: pp. 662-668.