It was with great interest we read the positions of Drs. Gunderman and Tobben on the elimination of the radiology residency clinical year and the rebuttal from Dr. Jackson advocating for continuation of the internship . Although it was briefly touched upon in Dr. Jackson’s editorial, we felt that the integrated clinical year deserves more consideration.
We have functioned with an integrated clinical year for the past several years at the University of Missouri—Kansas City, and the response to this from the other clinical teams has been unanimously positive. As mentioned by Dr. Jackson , with the implementation of the American College of Radiology’s Imaging 3.0 initiative, increasing the visibility of the radiologist not only with our colleagues and ordering clinicians but also with our patients is imperative. Having our residents actively a part of the clinical team after acquiring knowledge in radiology not only increases our profile, but also allows us to contribute in a more meaningful way to the team as compared to another intern just trying to make it through the rotation.
Our interaction with the team also serves as an excellent learning opportunity for both the resident and the clinical team. I am sure many can relate to the experience of reviewing an indication for a study, input by the ordering clinician, and not understanding why that particular test was ordered. In addition to actively helping the team through image interpretation and in some cases direct discussion of the imaging findings with the patients, our residents teach the ordering clinicians what studies would be appropriate in common clinical scenarios and that the radiology department in general is available to them to answer questions when they arise.
Our residents in turn learn how to mold their interpretations and dictations to answer the clinical question at hand. Getting real-time feedback from the clinical team on what they are looking for reinforces the behavior of answering the clinical question over simply stating findings.
Our program incorporates rotations in emergency medicine, neurology, and internal medicine during our postgraduate year 1. Often, before these rotations, our residents have had at least a month of neuroradiology, abdominal radiology, thoracic radiology, and musculoskeletal radiology, allowing them to not only see patients, write notes, and help in treatment, but also assist in image interpretation in real time. My own experience (SD) being able to evaluate stroke patient imaging on my emergency room rotations and chest radiographs on my intensive care unit rotation was extremely valuable and well received by my attendings.
Scattered throughout our remaining 4 years of training, we rotate with orthopedic surgery, high-risk obstetrics, and pediatrics, acting as members of the team as well as liaisons with radiology. Obviously, the initial setup of this type of program takes a lot of work, more than even a traditional intern year within the same institution, as there must be buy-in from the other departments and a clear understanding of the role of the radiology resident on the service.
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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. Heller R.L., Lowe L.H., Halpin J. Bridging the PACS-induced radiology-clinician interaction gap by incorporating a PGY-4 radiology resident into the general pediatrics team: is there support and what is the benefit? Poster session presented at the Association of University Radiologists Annual Meeting 2014.