- Email: [email protected]
A perspective on radiology residency curriculum guidelines: Results of the 1995 survey of program directors
A s s o c i a t i o n o f P r o g r a m D i r e c t o r s in R a d i o l o g y Lee B. Talner, MD, Editor
A Perspective on Radiology Residency Curriculum Guidelines: Results of the 1995 Survey of Program Directors Vijay M. Rao, MD
Rationale and Objectives. The development of curriculum guidelines for radiology residency has been found to be favored by 80% of program directors (PDs) nationwide. I surveyed PDs to develop a consensus of opinion concerning minimum training requirements in the subspecialty rotations. Methods. A survey developed by members of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology was mailed to all U.S. PDs. Results. One hundred forty-one (82%) completed responses were received. There was agreement among the PDs about the minimum length of training needed in the various subspecialties. Seventy-four percent of the PDs supported the concept of developing educational objectives and goals in each subspecialty and of specifying procedures in which residents should be trained. Only a minority of PDs thought that the training guidelines should specify minimum numbers of procedures. Conclusion. The consensus of PDs is that the radiology residency curriculum should include a minimum of 3 months in each of the following categories: chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body computed tomography (CT) scanning. In neuroradiology, inclusive of neuroangiography, neuro CT scanning, and neuro magnetic resonance (MR) imaging, a resident should spend 4 months. At least 2 months should be devoted to each of the following: uroradiology, mammography, body MR imaging, and emergency radiology. A majority of PDs also favored developing educational objectives for each of the subspecialty rotations. Key Words. Radiology resident curriculum; radiology program directors; survey.
he field of radiology has undergone explosive and unparalleled growth over the past two decades. The extent of scientific knowledge and the complexity of material to be learned by residents has increased manifold with the addition of newer technolqgies such as sonography, computed tomography (CT) scanning, a.nd magnetic resonance (MR) imaging to the diagnostic armamentarium. The American Board of Radiology (ABR) increased the required length of residency training from 3 to 4 years in 1984. The revised training guidelines v~ritten by the ABR, however, remain extremely broad and do not include a formal curriculum. Currently, there is little uniformity among the radiology programs regarding the length of time residents spend in the various subspecialty rotations. At each instirut!on, a master schedule of resident rotations; which is influenced greatly by the department's design, usually is created by the program director (PD). Because there are no guidelines regarding the length of time residents should spend in each rotation,-resident assignments may be influenced primarily by staffing needs. PDs have the difficult task of finding a balance between staffing needs and the residents' educational needs. A prior su,rvey of the PDs clearly showed strong support for the development of residency curriculum guidelines [1.]. This survey was conducted to obtain a consensus of opinion among PDs about the length of time residents should spend in each of the subspecialty rotations. PDs also were asked about the development of well-defined educational objectives for each of the subspecialty areas and whether the curriculum should include specific types and minimum numbers of procedures that residents must train in during the residency period.
T
From the Department of Radiology,Thomas Jefferson University Hospital, Philadelphia, PA. Address reprint requests to V. M. Rao, MD, Department of Radiology,Thomas Jefferson University Hospital, 132 S. 10th St., Philadelphia, PA 19107. Received September 28, 1995, and accepted for publication after revision February 19, 1996. Acad Radiol 1996;3:512-516
© 1996, Association of University Radiologists
512
Vol. 3, No. 6, June 1996
1995 SURVEY
OF PROGRAM
DIRECTORS
In the second half of the survey, PDs were asked to respond to five separate questions. The response choices included yes, no, or maybe. The university versus nonuniversity responses for the five questions were compared using the chi-square test.
MATERIALS AND METHODS
A questionnaire was designed with input from the m e m b e r s of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology (APDR). The survey was mailed to the entire m e m b e r s h i p of the APDR; however, only residency PDs were asked to complete it. There are approximately 170 residency programs in the United States w h o s e directors are m e m b e r s of the APDR. Residency PDs were asked to indicate the minimum number of months that residents should spend in each subspecialty area---chest radiology, gastrointestinal radiology, uroradiology, musculoskeletal radiology, mammography, pediatric radiology, nuclear radiology, abdominal radiology, neuroradiology and head and neck radiology, cardiovascular and interventional radiology, sonography, body CT scanning, body MR imaging, radiologic pathology, and emergency radiology--during the 4 years of residency training. The respondents were encouraged to leave the category blank ff they felt that it did not belong in the curriculum. In addition, there was space on the survey for respondents to indicate any other miscellaneous rotation that they felt should be included. The survey indicated that these were minimal guidelines and that they could therefore add up to less than 48 months. The number of months that had the most responses (mode) was tallied and reported as the suggested minimum for each category. Furthermore, the responses were divided into university-based programs and nonuniversity programs, and the two groups were compared.
RESULTS
A total of 141 responses were received, resulting in an 82% response rate. Of the 141 responses, 137 were usable. Four PDs chose to complete only the second half of the survey. Table 1 shows the distribution of responses for each of the subspecialty categories. The mode for chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body CT scanning was 3 months. The mode was 2 months each for uroradiology', mammography, abdominal radiology, body MR imaging, and emergency radiology and 4 months for neuroradiology. Table 1 also shows that nuclear radiology had a striking bimodal distribution. The comments suggested that many respondents allotted 6 months of training time to stay within the existing training requirements of the ABR. Seventy-four percent of the PDs favored developing educational objectives for each of the subspecialty areas (Fig. 1). A standardized curriculum to include types of procedures in which the residents should be trained also was favored by 74% of the PDs (Fig. 2). There was, however, less agreement for requiring a minimum number of specified procedures; one third of the responses were in favor, one third were not
TABLE 1: Responses Indicating Number of Months that Residents Should Spend in Each Category During 4 Years of Residency Training (n = 141) Months
Category 1 Chest
1.5
1
Gastrointestinal Uroradiology Musculoskeletal Mammography
Pediatric radiology Nuclear radiology Abdominal radiology Neuroradiology CVIR Sonography Body CT scanning Body MR imaging Emergency Rad-path/AFIP
14 1 12 17
2
3
4
5
12 22 63 32 77
56 52 44 71 44 81 31 18 36 55 59 67 31 22
52 44 12 28 2 37 54 5 71 49 55 34 8 11 2
11
4
5
11
5 20 5 6 10 22 61 49
4
2 25 25 121
6
3 2 3 2 11 11 5 0
44 1 11 11 4 1
CVIR = cardiovascular and interventional radiology, CT = computed tomography, MR = magnetic resonance, Rad-path = radiology pathology, AFIP = Armed Forces Instituteof Pathology.
513
RAO
VoI. 3, No. 6, June 1996
32%
18% n=14
n = 141
lYes
• Yes [] No [] M a y b e
~No
I
[]Maybe I
24%
74%
FIGURE 3. Responses to the statement, "A standardized curriculum should also define the numbers of specific procedures that residents should be exposed to:'
FIGURE 1. Responses to the statement, "A standardized curriculum with clearly defined educational objectives for each of the subspecialty areas should be developed"
25% n = 141 18%
U Yes ~No [~Maybe
5'
n = 14;
• Yes
[] No [] M a y b e
70% FIGURE 4. Responses to the statement, "A standardized curriculum would'create some consistency among the various residency programs"
74% FIGURE 2. Responses to the statement, "A standardized curriculum should specify types of procedures that residents would be exposed to in each subspecialty area"
34% n = 141
in favor, and the remaining third were unsure (Fig. 3). Seventy percent of the PDs agreed that a standardized curriculum would create consistency mnong the programs (Fig. 4). The final question revolved around decreasing board mania for senior residents ff a standardized curriculum were adopted. This stimulated several interesting comments from the PDs but no consensus (Fig. 5). These 141 responses were subdivided into two groups: university programs (n = 83) and nonuniversity programs (n = 58). The trends for both of these groups were analyzed using the chi-square test. The only significant relationship between the subgroup and response was for the question of a standardized curriculum to define specific types of procedures that residents should learn (p = .0464). The trend indicated that 85% of the nonuniversity hospital residency PDs were in favor of this specification, compared with 67% of the university hospital residency PDs. DISCUSSION The current ABR training requirements include 4 years of training in diagnostic radiology, of which a 514
[] Yes [] No [] Maybe
36%
30% FIGURE 5. Responses to the statement, "American Board of Radiology examinations based on a standardized curriculum would help decrease the 'board mania' among senior residents"
minimum of 6 months but no more than 12 months must be spent in nuclear radiology. Residents may spend no more than 8 months in rotation outside the parent institution. No more than 12 months may be spent in a single discipline, and designation of fellowship is reserved for training b e y o n d the 4-year residency. A m a x i m u m of 3 months m a y be spent in radiation oncology. In addition, candidates beginning training after January 1, 1997, will be required to have 5 years of a p p r o v e d training, with a minimum of 4 years
VoL 3, No. 6, June 1996
in diagnostic radiology and 1 year of clinical training. No more than 3 months out of the clinical year may be spent in radiology, pathology, or both [2]. The training requirements as fommlated by the ABR provide much desired flexibility in designing programs that allow PDs to capitalize on the strengths unique to each institution. On the other hand, this permits programs to be relatively free-floating, with minimal structure and organization that, in the face of staff shortages, might produce serious inconsistencies in training. A survey conducted by the American Association of Academic Chief Residents in Radiology revealed that approximately 15% of the programs totally lacked structured core rotations [3]. Resident assignments in such programs potentially may be driven by the service demands rather than by educational needs. There is merit in organized rotations that allow for residents to spend designated time periods in specific subspecialty areas under the supervision of full-time faculty with identified teaching responsibilities [4]. The results of this survey demonstrate a strong consensus of opinion among the PDs regarding the minimum length of training time in each subspecialty area. Most PDs in radiology thought that residents should spend a minimum of 3 months of training in each of the following subspecialties: chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body CT scanning. At least 2 months should be devoted to each of the following: uroradiology, mammography, MR imaging, and emergency radiology. The consensus of PDs suggested a minimum of 4 months of training in neuroradiology, inclusive of neuroangiography, neuro CT scanning, and neuro MR imaging. Most PDs favored 1.5 months in radiologic pathology because the majority of residents nationwide already attend a 6week course in radiologic pathology sometime during their residency training at the Armed Forces Institute of Pathology. Although concerns were expressed about excessive training requirements in nuclear radiology, most PDs acknowledged that it was prudent to comply with the Nuclear Regulatory Commission's guidelines. The results of the second half of this survey indicate that PDs endorsed development of a formal curriculum with well-defined educational objectives and goals. Such a core curriculum could provide a basic resource for the PDs and other faculty members to organize and direct their teaching efforts without mandating teaching meth-
1995 S U R V E Y OF P R O G R A M D I R E C T O R S
ods. Furthermore, residents could use such a resource to organize their independent study [5]. Several authors have reported that after the adoption of a formal curriculum, developed by internal committees, the residents' knowledge base and skills improved considerably [6, 7]. Although there was a majority consensus of PDs to develop curriculum guidelines, the support was not unanimous. Furthermore, they felt that input from the Society of Chairmen of Academic Radiology Departments, the ABR, and the Residency Review Committee for Radiology would be vital because of potential implications of such a move. However, note that some of the other medical specialties also are developing such curricula. For example, the Residency Review Committee of Internal Medicine recently proposed special new requirements for training programs in cardiovascular diseases. These requirements include (1) a minimum number of months of training needed in each cardiology subspecialty area (e.g., cardiac catheterization laboratory, noninvasive testing); (2) the minimum number of procedures in which a cardiology trainee should participate; and (3) a list of subjects in which a cardiolbgy trainee should acquire knowledge [8]. If organized radiology could be persuaded to go this route, the various subspecialty societies potentially could serve as a resource. Several of the subspecialty societies (e.g., Society of Thoracic Radiology, Society of Pediatric Radiology, Society of Cardiovascular/Interventional Radiology) already have initiated the process and developed a mission statement along with a preliminary curriculum for the residents. In the opinion of the APDR's Ad Hoc Curriculum Committee, all the subspecialty societies including, but not necessarily limited to, the 10 sections tested on the board examination could be asked to define the body of knowledge that trainees may be expected to learn well within the allotted time during their residency. The curriculum guidelines could be expanded to incorporate other aspects such as practice management and socioeconomic issues. It will be particularly challenging in the future to continue giving high priority to the education of residents in light of mounting economic pressures to increase the clinical workload. With the impending shrinkage of residents as well as faculty staffing resources, PDs will find it increasingly difficult to resolve conflicts between service demands and residents' educational needs. A set of curriculum guidelines may be critical to ensure the proper education of residents in the upcoming rough times.
515
RAO
Vol. 3, No. 6, June 1996
ACKNOWLEDGMEN'I-S
Thanks to Karer, Russell for conducting data analysis and JoAnn Gardn( c for manuscript preparation. Thanks also to the membe,s of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology: James Buck, GaB Dorfman, David Einstein, Deborah Forrester, Jay I-Infolds, Sandra Oldham, Stephen Swensen, and Chmles Resnik. Thanks to Lee Talner, Jerry Arndt, and David Levin for the constructive critique of the questionnaire and to Gregg Robinson and Kathy Thomas, of the American College of Radiology, for being instrumental in mading the surveys.
2.
3.
4.
5. 6.
7.
REFERENCES
8.
1. Gay SB, TaMer LB, Hunt RK, Mcllhenny J, Smith WL, Amdt JH. Current
status of residency programs: survey of program directors. Acad-Radiol 1995;2:254-259. The American Board of Radiology. Information for examination in diagnostic radiology and diagnostic radiology with special competence in nuclear radiology, 1995-1996. Tucson, AZ: American Board of Radiology, 1995. Oser AB, Baker SM, Wilson A J, Evens RG. Results of the 1993 survey of the American Association of Academic Chief Residents in Radiology. Acad Radio11994;1:154-158. Shackelford GD, Evens RG. A suggested curriculum for a four-year diagnostic radiology residency with emphasis on flexibility. Invest Radiol 1985;20:878-880. Chew FS. Standardization ofthe curriculum for resident education in diagnostic radiology. Invest Radiol 1990;25:1258-1260. Grabcwski WS, Redd RA, Cunningham BE, Martshorne MF, Timmons JH, Truwit CL. A categorical course curriculum for radiology residents. Invest Radio11988,23:312-315. Mundy WM, Binet E. A comprehensive objective-based curriculum for radiology residents. Acad Radio11995;2:173-178. Parmley WW. Changing requirements for training in cardiovascular diseases. J Am Coil Cardio11993;22:1548.
Announcements The 13th Annual Meeting o f t h e E u r o p e a n Society for Magnetic Resonance in Medicine a n d Biology will be held held ";eptember 12-15, 1996, in Prague, Czech Republic. For more inf(,rmation, contact the ESMRMB Office, Neutorgasse 9/2a, A-1010 Vienna, Austria; phone (43-1)535-13-06, fax (43-1)-533-40-649. Electronic mail may be sent to [email protected]; http://www.medicon.cz/ esmrmb.hyml. The Cardiac a n d Vascular MR Visiting Fellowship for Physicians is offered on an ongoing basis at the University of Pennsy],vania Medical Center in Philadelphia, PA. Forty hours of AMA Category 1 credit will be awarded. The course direct, ~r is Leon Axel, PhD, MD. The fee is $1,600. For more information, contact Melissa Zajdel, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein Bldg., Pl~dadelphia, PA 19104; (215) 662-7825, fax (215) 349-5925. The Musculoskeletal MR Visiting Fellowship for Physicians is offered on an ongoing basis by the University of Pennsylvania Medical Center in Philadelphia, PA. Forty hours of AMA Category 1 credit will be awarded. The course director is Murray K. Dalinka, MD. The fee is $1,600 (includes daily lunches). For more inf<,rmation, contact Melissa Zajdel, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein Bldg., Pffiladelphia, PA 19104; (215) 662-7825, fax (215) 349-5925. The University of Pennsylvania Medical Center is sponsoring the Abdominal Imaging Conference July 1-5, 1996, in Grand Teton National Park in Jackson Hole, WY. Twenty-four hours of Category 1 credit will be awarded. The course direcllor is Bernard Birnbaum, MD. The fees are $645 for radiologists and $395 residents and fellows. For more inf,)rmation, contact Janice Ford Benner, University of Pennsylvania Medical Center, 3400 Spruce St., 1 Silverstein Bldg., Philadelphia, PA 19104; (215) 662-6904, fax (215) 349-5925.
516
A Perspective on Radiology Residency Curriculum Guidelines: Results of the 1995 Survey of Program Directors Vijay M. Rao, MD
Rationale and Objectives. The development of curriculum guidelines for radiology residency has been found to be favored by 80% of program directors (PDs) nationwide. I surveyed PDs to develop a consensus of opinion concerning minimum training requirements in the subspecialty rotations. Methods. A survey developed by members of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology was mailed to all U.S. PDs. Results. One hundred forty-one (82%) completed responses were received. There was agreement among the PDs about the minimum length of training needed in the various subspecialties. Seventy-four percent of the PDs supported the concept of developing educational objectives and goals in each subspecialty and of specifying procedures in which residents should be trained. Only a minority of PDs thought that the training guidelines should specify minimum numbers of procedures. Conclusion. The consensus of PDs is that the radiology residency curriculum should include a minimum of 3 months in each of the following categories: chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body computed tomography (CT) scanning. In neuroradiology, inclusive of neuroangiography, neuro CT scanning, and neuro magnetic resonance (MR) imaging, a resident should spend 4 months. At least 2 months should be devoted to each of the following: uroradiology, mammography, body MR imaging, and emergency radiology. A majority of PDs also favored developing educational objectives for each of the subspecialty rotations. Key Words. Radiology resident curriculum; radiology program directors; survey.
he field of radiology has undergone explosive and unparalleled growth over the past two decades. The extent of scientific knowledge and the complexity of material to be learned by residents has increased manifold with the addition of newer technolqgies such as sonography, computed tomography (CT) scanning, a.nd magnetic resonance (MR) imaging to the diagnostic armamentarium. The American Board of Radiology (ABR) increased the required length of residency training from 3 to 4 years in 1984. The revised training guidelines v~ritten by the ABR, however, remain extremely broad and do not include a formal curriculum. Currently, there is little uniformity among the radiology programs regarding the length of time residents spend in the various subspecialty rotations. At each instirut!on, a master schedule of resident rotations; which is influenced greatly by the department's design, usually is created by the program director (PD). Because there are no guidelines regarding the length of time residents should spend in each rotation,-resident assignments may be influenced primarily by staffing needs. PDs have the difficult task of finding a balance between staffing needs and the residents' educational needs. A prior su,rvey of the PDs clearly showed strong support for the development of residency curriculum guidelines [1.]. This survey was conducted to obtain a consensus of opinion among PDs about the length of time residents should spend in each of the subspecialty rotations. PDs also were asked about the development of well-defined educational objectives for each of the subspecialty areas and whether the curriculum should include specific types and minimum numbers of procedures that residents must train in during the residency period.
T
From the Department of Radiology,Thomas Jefferson University Hospital, Philadelphia, PA. Address reprint requests to V. M. Rao, MD, Department of Radiology,Thomas Jefferson University Hospital, 132 S. 10th St., Philadelphia, PA 19107. Received September 28, 1995, and accepted for publication after revision February 19, 1996. Acad Radiol 1996;3:512-516
© 1996, Association of University Radiologists
512
Vol. 3, No. 6, June 1996
1995 SURVEY
OF PROGRAM
DIRECTORS
In the second half of the survey, PDs were asked to respond to five separate questions. The response choices included yes, no, or maybe. The university versus nonuniversity responses for the five questions were compared using the chi-square test.
MATERIALS AND METHODS
A questionnaire was designed with input from the m e m b e r s of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology (APDR). The survey was mailed to the entire m e m b e r s h i p of the APDR; however, only residency PDs were asked to complete it. There are approximately 170 residency programs in the United States w h o s e directors are m e m b e r s of the APDR. Residency PDs were asked to indicate the minimum number of months that residents should spend in each subspecialty area---chest radiology, gastrointestinal radiology, uroradiology, musculoskeletal radiology, mammography, pediatric radiology, nuclear radiology, abdominal radiology, neuroradiology and head and neck radiology, cardiovascular and interventional radiology, sonography, body CT scanning, body MR imaging, radiologic pathology, and emergency radiology--during the 4 years of residency training. The respondents were encouraged to leave the category blank ff they felt that it did not belong in the curriculum. In addition, there was space on the survey for respondents to indicate any other miscellaneous rotation that they felt should be included. The survey indicated that these were minimal guidelines and that they could therefore add up to less than 48 months. The number of months that had the most responses (mode) was tallied and reported as the suggested minimum for each category. Furthermore, the responses were divided into university-based programs and nonuniversity programs, and the two groups were compared.
RESULTS
A total of 141 responses were received, resulting in an 82% response rate. Of the 141 responses, 137 were usable. Four PDs chose to complete only the second half of the survey. Table 1 shows the distribution of responses for each of the subspecialty categories. The mode for chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body CT scanning was 3 months. The mode was 2 months each for uroradiology', mammography, abdominal radiology, body MR imaging, and emergency radiology and 4 months for neuroradiology. Table 1 also shows that nuclear radiology had a striking bimodal distribution. The comments suggested that many respondents allotted 6 months of training time to stay within the existing training requirements of the ABR. Seventy-four percent of the PDs favored developing educational objectives for each of the subspecialty areas (Fig. 1). A standardized curriculum to include types of procedures in which the residents should be trained also was favored by 74% of the PDs (Fig. 2). There was, however, less agreement for requiring a minimum number of specified procedures; one third of the responses were in favor, one third were not
TABLE 1: Responses Indicating Number of Months that Residents Should Spend in Each Category During 4 Years of Residency Training (n = 141) Months
Category 1 Chest
1.5
1
Gastrointestinal Uroradiology Musculoskeletal Mammography
Pediatric radiology Nuclear radiology Abdominal radiology Neuroradiology CVIR Sonography Body CT scanning Body MR imaging Emergency Rad-path/AFIP
14 1 12 17
2
3
4
5
12 22 63 32 77
56 52 44 71 44 81 31 18 36 55 59 67 31 22
52 44 12 28 2 37 54 5 71 49 55 34 8 11 2
11
4
5
11
5 20 5 6 10 22 61 49
4
2 25 25 121
6
3 2 3 2 11 11 5 0
44 1 11 11 4 1
CVIR = cardiovascular and interventional radiology, CT = computed tomography, MR = magnetic resonance, Rad-path = radiology pathology, AFIP = Armed Forces Instituteof Pathology.
513
RAO
VoI. 3, No. 6, June 1996
32%
18% n=14
n = 141
lYes
• Yes [] No [] M a y b e
~No
I
[]Maybe I
24%
74%
FIGURE 3. Responses to the statement, "A standardized curriculum should also define the numbers of specific procedures that residents should be exposed to:'
FIGURE 1. Responses to the statement, "A standardized curriculum with clearly defined educational objectives for each of the subspecialty areas should be developed"
25% n = 141 18%
U Yes ~No [~Maybe
5'
n = 14;
• Yes
[] No [] M a y b e
70% FIGURE 4. Responses to the statement, "A standardized curriculum would'create some consistency among the various residency programs"
74% FIGURE 2. Responses to the statement, "A standardized curriculum should specify types of procedures that residents would be exposed to in each subspecialty area"
34% n = 141
in favor, and the remaining third were unsure (Fig. 3). Seventy percent of the PDs agreed that a standardized curriculum would create consistency mnong the programs (Fig. 4). The final question revolved around decreasing board mania for senior residents ff a standardized curriculum were adopted. This stimulated several interesting comments from the PDs but no consensus (Fig. 5). These 141 responses were subdivided into two groups: university programs (n = 83) and nonuniversity programs (n = 58). The trends for both of these groups were analyzed using the chi-square test. The only significant relationship between the subgroup and response was for the question of a standardized curriculum to define specific types of procedures that residents should learn (p = .0464). The trend indicated that 85% of the nonuniversity hospital residency PDs were in favor of this specification, compared with 67% of the university hospital residency PDs. DISCUSSION The current ABR training requirements include 4 years of training in diagnostic radiology, of which a 514
[] Yes [] No [] Maybe
36%
30% FIGURE 5. Responses to the statement, "American Board of Radiology examinations based on a standardized curriculum would help decrease the 'board mania' among senior residents"
minimum of 6 months but no more than 12 months must be spent in nuclear radiology. Residents may spend no more than 8 months in rotation outside the parent institution. No more than 12 months may be spent in a single discipline, and designation of fellowship is reserved for training b e y o n d the 4-year residency. A m a x i m u m of 3 months m a y be spent in radiation oncology. In addition, candidates beginning training after January 1, 1997, will be required to have 5 years of a p p r o v e d training, with a minimum of 4 years
VoL 3, No. 6, June 1996
in diagnostic radiology and 1 year of clinical training. No more than 3 months out of the clinical year may be spent in radiology, pathology, or both [2]. The training requirements as fommlated by the ABR provide much desired flexibility in designing programs that allow PDs to capitalize on the strengths unique to each institution. On the other hand, this permits programs to be relatively free-floating, with minimal structure and organization that, in the face of staff shortages, might produce serious inconsistencies in training. A survey conducted by the American Association of Academic Chief Residents in Radiology revealed that approximately 15% of the programs totally lacked structured core rotations [3]. Resident assignments in such programs potentially may be driven by the service demands rather than by educational needs. There is merit in organized rotations that allow for residents to spend designated time periods in specific subspecialty areas under the supervision of full-time faculty with identified teaching responsibilities [4]. The results of this survey demonstrate a strong consensus of opinion among the PDs regarding the minimum length of training time in each subspecialty area. Most PDs in radiology thought that residents should spend a minimum of 3 months of training in each of the following subspecialties: chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body CT scanning. At least 2 months should be devoted to each of the following: uroradiology, mammography, MR imaging, and emergency radiology. The consensus of PDs suggested a minimum of 4 months of training in neuroradiology, inclusive of neuroangiography, neuro CT scanning, and neuro MR imaging. Most PDs favored 1.5 months in radiologic pathology because the majority of residents nationwide already attend a 6week course in radiologic pathology sometime during their residency training at the Armed Forces Institute of Pathology. Although concerns were expressed about excessive training requirements in nuclear radiology, most PDs acknowledged that it was prudent to comply with the Nuclear Regulatory Commission's guidelines. The results of the second half of this survey indicate that PDs endorsed development of a formal curriculum with well-defined educational objectives and goals. Such a core curriculum could provide a basic resource for the PDs and other faculty members to organize and direct their teaching efforts without mandating teaching meth-
1995 S U R V E Y OF P R O G R A M D I R E C T O R S
ods. Furthermore, residents could use such a resource to organize their independent study [5]. Several authors have reported that after the adoption of a formal curriculum, developed by internal committees, the residents' knowledge base and skills improved considerably [6, 7]. Although there was a majority consensus of PDs to develop curriculum guidelines, the support was not unanimous. Furthermore, they felt that input from the Society of Chairmen of Academic Radiology Departments, the ABR, and the Residency Review Committee for Radiology would be vital because of potential implications of such a move. However, note that some of the other medical specialties also are developing such curricula. For example, the Residency Review Committee of Internal Medicine recently proposed special new requirements for training programs in cardiovascular diseases. These requirements include (1) a minimum number of months of training needed in each cardiology subspecialty area (e.g., cardiac catheterization laboratory, noninvasive testing); (2) the minimum number of procedures in which a cardiology trainee should participate; and (3) a list of subjects in which a cardiolbgy trainee should acquire knowledge [8]. If organized radiology could be persuaded to go this route, the various subspecialty societies potentially could serve as a resource. Several of the subspecialty societies (e.g., Society of Thoracic Radiology, Society of Pediatric Radiology, Society of Cardiovascular/Interventional Radiology) already have initiated the process and developed a mission statement along with a preliminary curriculum for the residents. In the opinion of the APDR's Ad Hoc Curriculum Committee, all the subspecialty societies including, but not necessarily limited to, the 10 sections tested on the board examination could be asked to define the body of knowledge that trainees may be expected to learn well within the allotted time during their residency. The curriculum guidelines could be expanded to incorporate other aspects such as practice management and socioeconomic issues. It will be particularly challenging in the future to continue giving high priority to the education of residents in light of mounting economic pressures to increase the clinical workload. With the impending shrinkage of residents as well as faculty staffing resources, PDs will find it increasingly difficult to resolve conflicts between service demands and residents' educational needs. A set of curriculum guidelines may be critical to ensure the proper education of residents in the upcoming rough times.
515
RAO
Vol. 3, No. 6, June 1996
ACKNOWLEDGMEN'I-S
Thanks to Karer, Russell for conducting data analysis and JoAnn Gardn( c for manuscript preparation. Thanks also to the membe,s of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology: James Buck, GaB Dorfman, David Einstein, Deborah Forrester, Jay I-Infolds, Sandra Oldham, Stephen Swensen, and Chmles Resnik. Thanks to Lee Talner, Jerry Arndt, and David Levin for the constructive critique of the questionnaire and to Gregg Robinson and Kathy Thomas, of the American College of Radiology, for being instrumental in mading the surveys.
2.
3.
4.
5. 6.
7.
REFERENCES
8.
1. Gay SB, TaMer LB, Hunt RK, Mcllhenny J, Smith WL, Amdt JH. Current
status of residency programs: survey of program directors. Acad-Radiol 1995;2:254-259. The American Board of Radiology. Information for examination in diagnostic radiology and diagnostic radiology with special competence in nuclear radiology, 1995-1996. Tucson, AZ: American Board of Radiology, 1995. Oser AB, Baker SM, Wilson A J, Evens RG. Results of the 1993 survey of the American Association of Academic Chief Residents in Radiology. Acad Radio11994;1:154-158. Shackelford GD, Evens RG. A suggested curriculum for a four-year diagnostic radiology residency with emphasis on flexibility. Invest Radiol 1985;20:878-880. Chew FS. Standardization ofthe curriculum for resident education in diagnostic radiology. Invest Radiol 1990;25:1258-1260. Grabcwski WS, Redd RA, Cunningham BE, Martshorne MF, Timmons JH, Truwit CL. A categorical course curriculum for radiology residents. Invest Radio11988,23:312-315. Mundy WM, Binet E. A comprehensive objective-based curriculum for radiology residents. Acad Radio11995;2:173-178. Parmley WW. Changing requirements for training in cardiovascular diseases. J Am Coil Cardio11993;22:1548.
Announcements The 13th Annual Meeting o f t h e E u r o p e a n Society for Magnetic Resonance in Medicine a n d Biology will be held held ";eptember 12-15, 1996, in Prague, Czech Republic. For more inf(,rmation, contact the ESMRMB Office, Neutorgasse 9/2a, A-1010 Vienna, Austria; phone (43-1)535-13-06, fax (43-1)-533-40-649. Electronic mail may be sent to [email protected]; http://www.medicon.cz/ esmrmb.hyml. The Cardiac a n d Vascular MR Visiting Fellowship for Physicians is offered on an ongoing basis at the University of Pennsy],vania Medical Center in Philadelphia, PA. Forty hours of AMA Category 1 credit will be awarded. The course direct, ~r is Leon Axel, PhD, MD. The fee is $1,600. For more information, contact Melissa Zajdel, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein Bldg., Pl~dadelphia, PA 19104; (215) 662-7825, fax (215) 349-5925. The Musculoskeletal MR Visiting Fellowship for Physicians is offered on an ongoing basis by the University of Pennsylvania Medical Center in Philadelphia, PA. Forty hours of AMA Category 1 credit will be awarded. The course director is Murray K. Dalinka, MD. The fee is $1,600 (includes daily lunches). For more inf<,rmation, contact Melissa Zajdel, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein Bldg., Pffiladelphia, PA 19104; (215) 662-7825, fax (215) 349-5925. The University of Pennsylvania Medical Center is sponsoring the Abdominal Imaging Conference July 1-5, 1996, in Grand Teton National Park in Jackson Hole, WY. Twenty-four hours of Category 1 credit will be awarded. The course direcllor is Bernard Birnbaum, MD. The fees are $645 for radiologists and $395 residents and fellows. For more inf,)rmation, contact Janice Ford Benner, University of Pennsylvania Medical Center, 3400 Spruce St., 1 Silverstein Bldg., Philadelphia, PA 19104; (215) 662-6904, fax (215) 349-5925.
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