In October 2007, the American Board of Radiology (ABR) announced major changes to the structure, content, and timing of the certifying examinations for diagnostic radiology . Beginning in 2013, residents will take an initial “core exam” at the end of their third year of training, which will test for competency in all subspecialties of radiology, and then a final “certifying exam” 15 months after the completion of their radiology training, which will be concentrated in subspecialty areas of their choosing.
The changes implemented by the ABR reflect the increasing role of subspecialization in radiology. They also necessitate that all radiology training programs provide their residents with definitive experience in all subspecialties of radiology within the first 36 months of residency. The proposed changes are encouraging residency programs to rethink the traditional 4 + 1 paradigm of radiology training (4 years of general radiology and 1 year of subspecialty training) and restructure the postgraduate years 5 and 6 curricula to include a more focused fourth year. New training models have recently been proposed, and in some cases implemented, to adjust to the new exam and the evolving demands of the field .
We developed our 3/2 program in 2001, years before the ABR proposed its exam changes, but at a time in when was obvious to the faculty of our institution that the future of radiology was in subspecialization. Our curriculum was reorganized to allow increased subspecialty experience over 2 years instead of 1, increasing the scope and depth of the fellowship and allowing for protected research time. It was our expectation that this program would produce radiologists with increased subspecialty expertise, result in greater resident scientific output, and potentially attract more residents to academic careers. The purpose of this paper is to describe our experience in developing, implementing, and sustaining this new concept in radiology training.
Rationale for program
The restructuring of our program reflected several realities that had become evident to us by 2001: virtually all of our residents had gone on to subspecialty fellowship training, and the vast majority had elected to stay at our institution for their fellowships. Recognizing that most residents would be staying for 5 years for their general radiology and subspecialty training, it made sense to change the curriculum to provide both the additional subspecialty training and dedicated research time.
Like many programs, ours had included the occasional “3/2 resident,” typically a young physician-scientist who had demonstrated a proclivity for research during medical school and was therefore provided with extra time for research during the residency. Although these residents were invariably productive in research, the arrangement was otherwise suboptimal. The isolated 3/2 resident tended to be seen as somewhat different from the others, and clinical expectations were often lower for such residents than for the others. A 3/2 program, on the other hand, in which all residents are on the same track, creates a team experience and academic environment shared by all residents. It also allows the allotment of increased department resources and uniformly high clinical expectations for all residents.
Our department also enjoys a strong and stable faculty and a diverse offering of fellowships ( Table 1 ), both of which are necessary for a program model in which residents are required to stay for fellowship training.
Table 1
Clinical Faculty and Fellowship Positions, 2009
Section Faculty Positions Fellowship Positions Abdominal imaging 14 8 Breast imaging 7 2 Musculoskeletal imaging 5 4 Neuroimaging 9 8 Nuclear medicine 5 2 Pediatric radiology 6 2 Cardiothoracic radiology 9 2 Vascular interventional 5 3
An average of 27 of the 31 fellowship positions have been filled during the time of the 3/2 program. There are 12 residents per year.
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Implementation of the program
Curriculum
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Table 2
Five-Year Resident Schedule for the 3/2 Curriculum
Years 1–3 Year 4 Year 5 Cardiothoracic, 3 mo Cardiac/body magnetic resonance, 1 mo Fellowship, 12 mo Musculoskeletal, 3 mo Mammography, 1 mo Pediatric, 3 mo Nuclear medicine, 1 mo Neuroradiology, 4 mo Fellowship, 9 mo Mammography, 2 mo Gastrointestinal, 2 mo Genitourinary, 1 mo Ultrasound, 2 mo Body computed tomography, 3 mo Nuclear medicine, 3 mo Vascular interventional, 3 mo Emergency, 3 mo General (Veterans Affairs), 4 mo
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Resident Recruitment
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Fellowship Choice
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Research
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Table 3
Increased Academic Productivity of Residents After Implementation of the 3/2 Program
Before 3/2 Implementation Since 3/2 Implementation 2006 2007 2008 2009 Publications ∗ 5 6 10 34 National presentations 4 3 6 24 Research awards † 0 0 0 5
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3/2 Mentors
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3/2 Enhancements
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Effect on existing fellowships
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Applicability
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Conclusions
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References
1. Alderson P.O., Becker G.J.: The new requirements and testing for American Board of Radiology certification in diagnostic radiology. Radiology 2008; 248: pp. 707-709.
2. Larson D.B., Saket D.D.: My old Kentucky home, goodnight: potential impact of planned changes in the radiology board certification process. AJR Am J Roentgenol 2008; 190: pp. 1149-1151.
3. Sunshine J.H., Lewis R.S., Bhargavan M.: Diagnostic radiologists’ subspecialization and the new final board examination. AJR Am J Roentgenol 2008; 191: pp. 1293-1301.
4. Arenson R., Dunnick N.R.: Training a better radiologist. J Am Coll Radiol 2006; 3: pp. 389-393.
5. Atlas S.W.: Embracing subspecialization: the key to the survival of radiology. J Am Coll Radiol 2007; 4: pp. 752-753.