Downloaded from www.ajronline.org by 117.255.241.166 on 11/06/15 from IP address 117.255.241.166. Copyright ARRS. For personal use only; all rights reserved
1 9i
Perspective
Fellowship Curtis
Training
for All?
E. Green1
At the i 989 meeting of the Association of University ologists, a lively open discussion centered on current lems in radiology resident and fellow education. Much discussion concerned two issues: (i ) How do we train academic radiologists? and (2) How do we maintain the and credibility of our specialty debates about recertification
specialized two
main
cation
procedures? camps,
of radiologic
who
seemed
believe
subspecialists
to be divided
that
the
will result
formal
in more
of the first
not command the radiologic
are concerned
that
general
into
will
from their clinical colleagues that can. These two viewpoints may not be as disparate as one might think at first glance. First, we must realize that because most nonacademic practices cannot afford to employ a subspecialist in all areas
of radiology,
the respect subspecialist
the
general
radiologist
is and
always
will
be our
primary ambassador to private medicine. We as educators are therefore obligated to train residents destined for private practice well. A 4-year training period should be adequate to accomplish this if properly organized, as many are. The fundamental core of knowledge should include at least the following: 1
expertise including 2. expertise .
abdominal
1
Department
AJR 155:191-192,
in the interpretation mammograms in the interpretation imaging
of Radiology,
studies
Georgetown
5.
of all plain
films
including
University
July 1990 0361-803x/90/1551-0191
barium
Hospital,
3800
© American
of and
Reservoir Roentgen
MR
imaging,
CT,
and
a working
knowledge
of nuclear
medicine
understanding of in various organ
systems.
When, then, is some form of subspecialty training either desirable or necessary for the private practitioner? One can make a strong case that it is only in those areas where special technical skills are required such as neuroradiology, cardiovascular/interventional
ditional
years
it well,
but
radiology,
and
pediatric
radiology.
Ad-
of training in other areas may not be necessary when the resident has had a good core education. A different situation exists when one considers academic practice. Here each staff member is usually expected to develop enough expertise in a specific area not only to teach also
many radiology they emphasize
to
do
investigational
work.
fellowships fall woefully the clinical aspects
short to the
In this
regard,
of ideal because exclusion of re-
search skills. As a result, in many cases we are doing nothing more than giving our residents a few more credentials with which
and supervision
studies,
6. most importantly, a thorough diseases and their expression
academic
radiologists
contrast
sonography 3. expertise in cross-sectional imaging of the chest and bones 4. an understanding of the basics of neuroradiology, cardiovascular radiology, and interventional radiology and the ability to perform and interpret basic procedures in these areas
certifi-
radiologists and those who believe that we should concentrate on training better general radiologists. Those who adhere to the second philosophy worry that further subspecialization will lead to fragmentation of our speciality, and those in favor
other
as well as our turf in the ongoing and performance of various
The group
those
Radiprobof the more quality
they
can find a good
private
job.
are in large part funded out of practice a poor policy to pursue.
Ad., NW.,
Washington,
Ray Society
DC 20007-2197.
Address
As fellowship
positions
plan funds,
this seems
reprint
requests
to C. E. Green.
GREEN
i 92
Our current attract
talented
by gaining
their
Downloaded from www.ajronline.org by 117.255.241.166 on 11/06/15 from IP address 117.255.241.166. Copyright ARRS. For personal use only; all rights reserved
it by providing
system young
interest training
of fellowship radiologists
through that
training does not help to to academia. That is done our enthusiasm and keeping
equips
them
with
the
tools
they
need to become investigators as well as experts in their chosen subspecialty. Furthermore, we must eliminate the “junior staff revolving door,” where the junior faculty leave after a short time of being overworked and underpaid, doing all the teaching, and being poorly supported in their investigative efforts, while the older faculty travel, make money, and generally dump their responsibilities on theirjunior colleagues. I believe that if we provide the leadership and opportunity, we will have no trouble finding high-quality residents willing to enter academic practice.
AJA:155, July 1990
In summary, we must maintain of at least 4 years, which should
general radiology
intensive residency training fully qualify the resident in
as well as in body CT, MR, and sonography
(currently one of the most popular fellowships). Fellowship years should be reserved and designed for the training of academic radiologists (unless there is an important need for specialized skills in private practice). The primary purpose of this additional training should be the acquisition of academic skills while in pursuit of further clinical expertise. To this end, we must stop treating fellows as cheap staff and regard them as an investment in the future. Our future as a specialty, both in the private world and in academia, depends on our ability to achieve both of these
important
and in no way mutually
exclusive
goals.
1 9i
Perspective
Fellowship Curtis
Training
for All?
E. Green1
At the i 989 meeting of the Association of University ologists, a lively open discussion centered on current lems in radiology resident and fellow education. Much discussion concerned two issues: (i ) How do we train academic radiologists? and (2) How do we maintain the and credibility of our specialty debates about recertification
specialized two
main
cation
procedures? camps,
of radiologic
who
seemed
believe
subspecialists
to be divided
that
the
will result
formal
in more
of the first
not command the radiologic
are concerned
that
general
into
will
from their clinical colleagues that can. These two viewpoints may not be as disparate as one might think at first glance. First, we must realize that because most nonacademic practices cannot afford to employ a subspecialist in all areas
of radiology,
the respect subspecialist
the
general
radiologist
is and
always
will
be our
primary ambassador to private medicine. We as educators are therefore obligated to train residents destined for private practice well. A 4-year training period should be adequate to accomplish this if properly organized, as many are. The fundamental core of knowledge should include at least the following: 1
expertise including 2. expertise .
abdominal
1
Department
AJR 155:191-192,
in the interpretation mammograms in the interpretation imaging
of Radiology,
studies
Georgetown
5.
of all plain
films
including
University
July 1990 0361-803x/90/1551-0191
barium
Hospital,
3800
© American
of and
Reservoir Roentgen
MR
imaging,
CT,
and
a working
knowledge
of nuclear
medicine
understanding of in various organ
systems.
When, then, is some form of subspecialty training either desirable or necessary for the private practitioner? One can make a strong case that it is only in those areas where special technical skills are required such as neuroradiology, cardiovascular/interventional
ditional
years
it well,
but
radiology,
and
pediatric
radiology.
Ad-
of training in other areas may not be necessary when the resident has had a good core education. A different situation exists when one considers academic practice. Here each staff member is usually expected to develop enough expertise in a specific area not only to teach also
many radiology they emphasize
to
do
investigational
work.
fellowships fall woefully the clinical aspects
short to the
In this
regard,
of ideal because exclusion of re-
search skills. As a result, in many cases we are doing nothing more than giving our residents a few more credentials with which
and supervision
studies,
6. most importantly, a thorough diseases and their expression
academic
radiologists
contrast
sonography 3. expertise in cross-sectional imaging of the chest and bones 4. an understanding of the basics of neuroradiology, cardiovascular radiology, and interventional radiology and the ability to perform and interpret basic procedures in these areas
certifi-
radiologists and those who believe that we should concentrate on training better general radiologists. Those who adhere to the second philosophy worry that further subspecialization will lead to fragmentation of our speciality, and those in favor
other
as well as our turf in the ongoing and performance of various
The group
those
Radiprobof the more quality
they
can find a good
private
job.
are in large part funded out of practice a poor policy to pursue.
Ad., NW.,
Washington,
Ray Society
DC 20007-2197.
Address
As fellowship
positions
plan funds,
this seems
reprint
requests
to C. E. Green.
GREEN
i 92
Our current attract
talented
by gaining
their
Downloaded from www.ajronline.org by 117.255.241.166 on 11/06/15 from IP address 117.255.241.166. Copyright ARRS. For personal use only; all rights reserved
it by providing
system young
interest training
of fellowship radiologists
through that
training does not help to to academia. That is done our enthusiasm and keeping
equips
them
with
the
tools
they
need to become investigators as well as experts in their chosen subspecialty. Furthermore, we must eliminate the “junior staff revolving door,” where the junior faculty leave after a short time of being overworked and underpaid, doing all the teaching, and being poorly supported in their investigative efforts, while the older faculty travel, make money, and generally dump their responsibilities on theirjunior colleagues. I believe that if we provide the leadership and opportunity, we will have no trouble finding high-quality residents willing to enter academic practice.
AJA:155, July 1990
In summary, we must maintain of at least 4 years, which should
general radiology
intensive residency training fully qualify the resident in
as well as in body CT, MR, and sonography
(currently one of the most popular fellowships). Fellowship years should be reserved and designed for the training of academic radiologists (unless there is an important need for specialized skills in private practice). The primary purpose of this additional training should be the acquisition of academic skills while in pursuit of further clinical expertise. To this end, we must stop treating fellows as cheap staff and regard them as an investment in the future. Our future as a specialty, both in the private world and in academia, depends on our ability to achieve both of these
important
and in no way mutually
exclusive
goals.
