Rationale and Objectives
With the restructuring of radiology board certification, many residencies created PGY-5 “mini-fellowships,” during which residents spend focused time pursuing advanced subspecialty training or developing nonclinical skills in leadership, health policy and health-care economics, education, quality improvement, informatics, research, or global health. We surveyed graduates of an academic diagnostic radiology residency to assess the relative value and impact of PGY-5 mini-fellowships on career satisfaction and success.
Methods
From 2012 to 2016, 39 radiology residents at our institution were offered the opportunity to pursue a 3- to 6-month mini-fellowship during the PGY-5 year. Thirty of 39 radiology residents (77%) participated, whereas 9 of 39 (23%) opted out. Of 39 residents, 13 completed two clinical mini-fellowships, 3 completed research mini-fellowships only, and 14 completed one nonclinical and one clinical mini-fellowship. Through SurveyMonkey, 23 of 39 residents (59%) responded to a questionnaire that collected basic demographic information and asked respondents about the value of this experience as it relates to fellowship choice and career using a five-point Likert scale.
Results
Of 23 respondents (14 male, 8 female,1 not specified), 78.3% practice in an academic university-based setting, with 8.7% in a community-based hospital practice, 4.3% in the veterans system, and 4.3% in a private practice setting. Of 23 respondents, the most popular clinical mini-fellowships were magnetic resonance imaging (31.6%), neuroradiology (21.1%), and interventional radiology (15.8%). For nonclinical mini-fellowships, the most popular were research (10.5%), education (10.5%), global health (5.3%), and healthcare economics (5.3%). Of 23 respondents who did mini-fellowships, 95% felt that the mini-fellowship prepared them well for their career, 85% felt it gave them the necessary skills to succeed, 85% cited that it gave them additional skills beyond their peers, and 40% felt it helped them create a life-long connection to a mentor. Ninety-five percent of respondents would choose to do the mini-fellowship again. Respondents suggested increasing the duration to 6–9 months and to develop a more structured curriculum and mentorship component. Only one respondent felt that the nonclinical mini-fellowship took away time from furthering clinical skills.
Conclusions
Graduates of a university-affiliated academic radiology residency who participated in clinical and nonclinical mini-fellowships during the PGY-5 year of residency greatly value this experience and uniformly recommend that this type of program continue to be offered to trainees given its ability to develop skills perceived to be vital to ultimate career satisfaction and success.
Introduction
Residency education has undergone a substantial change over the past decade. As part of the Accreditation Council for Graduate Medical Education (ACGME) introducing a new accreditation system based on EPAs (entrustable professional activities), residency program leadership has implemented new methods for trainee assessment. These include the creation of clinical competency committees and program evaluation committees, the adoption of milestones to aid in assessment of resident performance in the core competencies, clinical learning environment and review visits every 18 months, and a comprehensive self-study process whereby programs are now assessed not only on meeting standards but also on their innovative educational initiatives and self-improvement .
In 2010, around the same time as the ACGME changed the accreditation process, the American Board of Radiology implemented a new model for board certification of practicing radiologists in the United States . Although undertaken in part to comply with the certifying process of other medical subspecialties, one of the other intents was to make it possible for residents to be more clinically engaged during their final year of training. Hence, the board certification was restructured such that trainees would take the core examination after 36 months of residency training, followed by the certifying examination approximately 15 months after residency training was completed. In addition, the certifying examination includes a general diagnostic imaging module followed by three candidate-selected specialty-specific modules, a model that encourages subspecialization in one or more areas of clinical radiology. As a consequence of the change in timing of these examinations, many residency programs introduced novel and innovative educational options for trainees in their PGY-5 year. Such a curriculum permits trainees to spend additional time honing skills in subspecialty areas of diagnostic and interventional radiology other than those developed during formal 1-year fellowship programs. One such example consists of offering both advanced clinical and nonclinical “mini-fellowships” in areas pertinent to the practice of radiology. A mini-fellowship is defined as an advanced clinical experience of at least 3 months where a resident in his or her final year of residency training takes on the responsibilities essentially equivalent to a fellow. Depending on the training program and its size, the duration of such a mini-fellowship varies between 3 and 12 months, and the actual curricular content also depends on the learning objectives set by each program.
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Methods
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Results
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Discussion
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TABLE 1
Demographics of Those Who Completed Mini-fellowships
Gender Male 14 Female 8 Not specified 1 Graduating class Class of 2016 8 Class of 2015 4 Class of 2014 7 Class of 2013 4 Class of 2012 0 Current practice setting Academic University based 18 Managed care provider network/HMO/large multisite group practice or network 2 Private office/imaging center/single site private medical practice group 1 Community hospital based 2 Fellowship training Neuroradiology 3 Breast imaging 5 Interventional radiology 6 Musculoskeletal imaging 5 Abdominal imaging 1 MRI 3 Pediatric radiology 3
HMO: health maintenance organization; MRI, magnetic resonance imaging.
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Appendix
Specific Survey Questions That Were Distributed by Email to Graduates of the Residency Program
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Mini-fellowship Information:
For each Mini-fellowship, a few additional Likert based questions were asked:
Rationale for Non-Participation:
Additional Likert-based questions:
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