[Introduction]   [Clinical rotations]   [On-call experience]

[Conferences]   [Research Activities]   [General Competencies]

Introduction

The diagnostic radiology residency training program is designed to prepare physicians for the clinical practice of radiology, while at the same time exposing them to the fundamentals of research in academic medicine. This is accomplished through intensive training with one-on-one teaching by faculty members during the daily interpretation of a large number of clinical cases and with formal teaching conferences. Frequent interactions with clinical physicians and patients, which are closely monitored, enhance clinical understanding and communication skills. In addition, through lectures and seminars, the residents are exposed to the principles of radiology research.

Upon completion of the residency-training program, it is expected that residents will have acquired substantial radiologic medical knowledge and will have learned to apply this knowledge to all aspects of the daily practice of radiology. Residents also will have participated actively in radiologic research (having presented their own clinical or basic science research both within the department and at a national meeting, many having prepared a manuscript for publication). Additionally, they will have learned how to be careful critical reviewers of the radiologic literature. Further, they will have developed an understanding of the role of the radiologist in the overall field of medicine today, as well as in the larger society. Finally, they will have learned to be diligent and conscientious workers who are caring and compassionate and who are able to communicate clearly and easily with patients, fellow physicians, and other health care personnel.

Clinical rotations

Subspecialty rotations are organized to provide the resident with graded and increasingly sophisticated experiences as the residency program progresses.
 

First Year Curriculum
During the first eight months of the first year of residency, trainees have core rotations in which they are exposed to the basic plain film modalities (chest radiology, gastrointestinal radiology, genitourinary radiology, musculoskeletal imaging, and pediatric radiology) as well as nuclear radiology. At the conclusion of these initial rotations, the residents are expected to have learned the imaging appearance of normal anatomy and basic pathology. Additionally, trainees are taught to perform a number of basic procedures, including arthrograms, barium studies, cystograms, and retrograde urethrograms.

Following these core rotations, residents are assigned to the first of two, week long, day-evening emergency department rotations (daily hours: 1:15 pm - 10:00 pm). On the ER rotation, residents have the opportunity to apply their newly acquired knowledge to acute care imaging under close faculty supervision (faculty members are available in the hospital at all times to review emergent radiographs).

First year residents also receive introductory training in body CT, neuroradiology (where they are primarily assigned to interpret neuro-CT examinations and to perform myelography), and ultrasonography (where they are expected to learn basic imaging anatomy and some basic pathology). They are assigned to one rotation at the Veterans Administration Hospital (where they concentrate on plain film interpretation and basic GI and GU procedures). Some first year residents will have their first rotations on vascular interventional radiology. In addition, first year residents are expected to learn a number of other skills, including acquiring facility with the hospital information and radiology PACS systems, dictating radiology reports, communicating unexpected results to referring physicians, and presentation skills including use of radiology images in teaching conferences.

Second Year Curriculum

During the first eight months of the second year, resident training is expanded to include more intense exposure to the cross-sectional imaging modalities and to interventional procedures. Residents return to body CT, neuroradiology and ultrasound for second rotations. Their responsibility on these services increases. For example, on the body CT service they are expected to review the emergent cases from the night before and daytime emergent cases. Second year residents also spend dedicated time learning to interpret Chest CT scans, cardiac imaging studies (on a cardiac CT/MR rotation) and neuro-MRI studies (on a dedicated neuro-MRI rotation). They are assigned to a second pediatric radiology rotation, during which time they are exposed to cross-sectional imaging studies in children. Additionally, second year residents receive their initial, or additional, exposure to procedures during rotations in vascular/interventional radiology and cross-sectional interventional radiology. Second year residents also rotate onto the breast imaging and body MRI services for the first time, and return to gastrointestinal radiology, nuclear radiology, and the VA Hospital for additional experience.

Many of the early second year rotations are considered essential prior to resident senior, or "Superchief", call where residents render preliminary interpretations for all cross-sectional imaging studies performed during weekends, holidays, and nights. This on call responsibility does not commence until March of second year and is described in greater detail elsewhere.

Second year residents will cover the ER at overnight, from July through June, in one week blocks, from 10 pm – 8 am, on the ER “Nightfloat” rotation. Responsibilities are similar to daytime ER coverage, with the addition of nuclear medicine studies. However, residents on Nightfloat are much more independent. Although more senior residents, and ER Radiology faculty members, are in the hospital, the Nightfloat resident is interpreting different studies (plain films, fluoroscopy, and nuclear medicine) and will not have their cases staffed by faculty until the morning. This graded responsibility to independent work is considered a critical component of radiology training.

Third Year Curriculum
During their third year, residents are expected to greatly augment the basic training they received during the first two years. Residents return to many of the plain film rotations (chest radiology, musculoskeletal radiology, and pediatric radiology) and also receive advanced training in the cross-sectional areas (CT, neuroradiology, and ultrasonography). Residents will return to nuclear radiology, pediatric radiology, and the Veterans Administration Hospital for a third time and spend three to four more weeks on vascular/interventional radiology service. Third year residents receive one month of elective time, with rotations in body MRI and clinical research most frequently chosen.

Third year residents also, with rare exceptions, attend the Armed Forces Institute of Pathology (AFIP) radiology-pathology correlation course. Those few residents who choose not to attend the AFIP course receive incremental radiology pathology correlation training at the University of Michigan by attending additional interdepartmental conferences, and are also granted additional money for their resident book fund to help offset the loss of the AFIP didactic experience.

Fourth Year Curriculum
The fourth year is constructed around a flexible schedule. Fourth year residents are given the freedom to tailor their rotation experience to their individual preferences. There are now only a few required fourth year rotations: a third experience on the breast imaging service, a second rotation in genitourinary radiology, the balance of the nuclear radiology requirement (so that the total time in nuclear radiology equals the requisite 16 weeks), and final rotations in chest radiology, neuroradiology, pediatric radiology, and at the VA. Fourth year residents receive up to 4-5 months of elective time in the fourth year (with rotations in MRI and clinical research again most frequently chosen).

Duration of Rotations
In general, in the first year, residents rotate simultaneously in four-week blocks, an exception being the ER rotation which is in one week blocks. In the second, third, and fourth years, residents generally spend three or four consecutive weeks on a rotation. Occasionally, a resident may be assigned to a service for only one or two weeks. This is done to cover for another resident who is on vacation or because the resident has specifically requested a shorter rotation as part of his or her elective time.

Faculty Supervision
Virtually all rotations are organized to provide the resident with increasing responsibility, as he or she becomes more senior. These responsibilities are explicitly stated in the written goals and objectives for each rotation.

Although faculty supervision is mandatory throughout the residency, emphasis is increasingly placed on giving the resident the opportunity to make independent decisions, which are then reviewed by a faculty member. Residents are given graded responsibility in image analysis, reporting of results, and the performance of procedures. All resident-dictated reports are read and signed by residents, then reviewed and countersigned by faculty members.

On-call experience

In order to provide progressive resident responsibility, a three-tiered resident call system is utilized.

ER Coverage
Beginning in February of first year residents begin covering ER plain films and adult fluoroscopy studies on an afternoon shift rotation from 1:15 pm (after noon conference) until 10 pm. Direct faculty supervision is provided throughout this shift with all cases staffed by an attending radiologist before the resident leaves at 10 pm. First year residents are scheduled for two one-week rotations and other residents for a single week total.

Junior Call Pool
Second year residents, beginning in July of second year and continuing through June, will cover the ER overnight from 10 pm until 8 am, on a “Nightfloat” rotation. Residents on average will have 5 weeks of Nightfloat in their second year. Residents on “Nightfloat” are responsible for interpreting plain radiographs on emergency department patients and on some inpatients. They also occasionally review emergent radiographs from outpatient clinics. Additionally, these junior residents perform and interpret emergent adult fluoroscopic gastrointestinal and genitourinary studies and emergent nuclear radiology studies.
Radiographs are staffed by a faculty member beginning at 7 am the following morning. Informal help is also available to the junior residents on “Nightfloat”; senior residents (overnight), and radiology faculty members covering cross sectional imaging cases (until 3 am), are available in the hospital for consultation. In addition, a faculty member is assigned to be available by telephone and pager overnight.

Senior Call Pool
The senior call pool (termed "Superchief" call) begins in March of second year and continues for 24 months. The senior call resident is responsible for interpreting body and neuroradiology cross-sectional imaging studies (CT, ultrasound, and MRI), and pediatric GI/GU studies. Senior call is taken on a rotating basis (typically with 22 residents in the call pool).
During the week, the senior “primary” on-call resident begins call duties at 5:00 pm. Faculty in chest radiology, body CT, and neuroradiology remain in the hospital until 6:00 pm. On call responsibilities continue until 8:00 am, at which time the resident is excused to go home. Residents, therefore, do not work more than 24 consecutive hours. A "back-up" on-call senior resident works from 6 pm until 2 am. This is a rotation assignment, assigned in one week blocks beginning as early as November of second year. In addition to interpreting cross sectional ER and urgent inpatient cases, the “back-up” resident is responsible for emergent cases requiring attendance at the VA Hospital performing emergent pediatric GI or GU studies, and to assist faculty with cross-sectional interventional procedures. These additional responsibilities are not commonly demanding as most VA cases can be interpreted via teleradiology and pediatric and cross-sectional interventional procedures are not common.

During weekends and holidays, residents not on the “back up” one week rotation typically take call. The "back up" resident arrives at 8:00 am and works until 7:00 pm and the “primary” on-call resident arrives at 12 noon and works until the following morning at 8:00 am. The “back up” resident remains available by pager for additional assistance should he or she be needed. Additional in house resident presence may be required if there is an emergent case requiring attendance at the VA Hospital or if there is an emergent GI or GU study on a pediatric patient.
Faculty support of the senior call resident is extensive. An Emergency Radiology faculty member interprets cases (after resident preliminary reports are rendered) from 6 pm to 3 am every day.  Five different subspecialty faculty call pools are also available for consultation by phone or pager 24 hours a day: CT, neuroradiology, pediatric radiology, ultrasound, and MRI. In addition, subspecialty faculty members come in to the hospital at least once a day on weekends and holidays to staff out emergent cases from that day or the night before, as well as ongoing cases. The CT and ultrasound faculty make two trips to the hospital each day, one in the morning and one in the evening.

Conferences

Teaching Clinical Radiology
Teaching conferences represent a major component of the residency curriculum. The centerpiece of resident teaching is the daily noon conference (which is held for all residents beginning in August and which continues until the following June). There are two 45-minute teaching conferences every day. Radiology Grand Rounds is held on Wednesdays 5-6 pm.

The noon conferences are designed entirely to teach residents. A monthly schedule assigns faculty from the various radiologic subspecialties to give the noon conferences. The primary format is case presentation and problem solving. Conferences are designed to teach residents the proper approach to image interpretation, pattern recognition, and formulation of appropriate differential diagnoses. Residents are also expected to make appropriate management recommendations. Residents participate by discussing unknown cases before their peers with the guidance of the assigned faculty member. In addition to radiologic features, clinical, laboratory, and pathologic manifestations of diseases are discussed. On occasion, faculty members may give didactic lectures instead of case presentation conferences. This alteration is made at the discretion of the assigned faculty member.

Four series of conferences are provided for residents at a specific level of training.

• Introductory noon conference lectures are given to first year residents during the summer, during which time these beginning residents receive a group of lectures on the basic organization of the plain film rotations in chest, gastrointestinal, genitourinary, musculoskeletal, and nuclear radiology. Residents are also taught how to approach radiographic images obtained in each of these areas, the appearance of normal anatomy, and basic pathology is present, as well.
• First year residents also receive a series of conferences at 5 pm during January and February. These afternoon conferences specifically address imaging of the acutely ill patient and are provided in preparation for the ER and Nightfloat rotations.
• Second year residents receive a series of conferences at 5 pm during January and February in preparation for taking senior call. These lectures focus on cross sectional imaging of the acutely ill patients.
• Finally, senior board review conferences are presented by faculty members daily to fourth year residents from 7:00-8:00 am and from 5:00 to 6:00 pm in March, April, and May. Noon conferences during these months also largely focus on oral board review topics and preparation, but are inclusive of residents from all years in the program.

Teaching of Non-Interpretive Skills
Conferences are provided for all residents at noon on a monthly basis (from September through May) to instruct the residents on aspects of the practice of Diagnostic Radiology other than image interpretation. The first series, entitled "Beyond Imaging", is given biannually. Topics in the series may include research in radiology, job seeking and contract negotiation, business aspects of radiology, critical thinking, information technology, ethics, professional radiologic organizations, ACR standards and appropriateness criteria, service orientation and interpersonal skills, and radiation biology.

Another conference series is designed to expose residents to both basic science and clinical research in radiology. Most topics are taught by both a basic research scientist and a radiologist.
In addition, formal journal club conferences focus on details of research techniques and the background needed to design and implement research projects, as well as discussions on critically interpreting the medical literature.

Monthly Resident Meetings
Residents participate in an additional noontime activity on a regular basis: the monthly resident meeting. These meetings, which are held in lieu of a noon teaching conference, serve as an opportunity for residents to exchange ideas/concerns with the Residency Training Program Director and/or the Associate Director. Discussions cover many different issues, including the radiology residency-training program at the University of Michigan and topics that pertain to radiology residents and physicians across the country. These are an extremely valuable and vital component of residency training. Discussed issues range from on-call frustrations and criticisms of clinical rotations to planning social events. Feedback on the residency program, from residents, is constantly solicited. Some of the most successful and beneficial changes in the organization of our residency program have resulted from suggestions made by residents.
 

Other Conferences
Residents are expected to attend each of the Radiology Grand Rounds lectures, held on Wednesdays from 5-6 pm. These one-hour sessions are designed for attendance by the entire radiology department and interested clinicians from other services. Topics vary and include research presentations, general didactic lectures, debates on cutting edge radiology controversies, and resident presentations. Each resident is responsible for a 15-20 minute presentation during Radiology Grand Rounds during his or her third year. Presentations may consist of discussion of a research project, review of a disease entity, or another radiology topic of interest. The resident Grand Rounds presentations are prepared under the guidance of a faculty mentor.

Residents in their late first and early second year are expected to attend the annually presented summer conferences in radiology physics. These 90 minute conferences are usually held in June, July and August at noon and are primarily tailored for second year residents, or any other residents, who will be taking the written physics component of the American Board of Radiology Examination the following September. Additionally, late first-early second year residents are expected to attend a separate course in nuclear radiology physics  held from May through July. This course consists of 35 1-hour lectures, presented in the morning 7:30 - 8:30 am.

Residents are encouraged to attend the four-week course in Radiologic-Pathologic Correlation offered by the Armed Forces Institute of Pathology. The majority of residents attend this course during their third year.

Residents are encouraged to attend journal clubs, which are held during noon conference quarterly on general topics, and which are held monthly on subspecialty topics in Breast Imaging and Vascular Interventional Radiology.

Finally, most radiologic subspecialty services have weekly or biweekly morning subspecialty conferences. These conferences are held for residents, fellows, and faculty members. Resident attendance is expected at these conferences when the resident is rotating on that service. Residents are encouraged to attend these conferences when rotating on other services. Residents often participate integrally in preparation of the subspecialty conferences. They are frequently responsible for accumulating interesting cases, for reading about the disease entities they have encountered, for communicating their knowledge to all conference attendees, and for preparing an electronic presentation of these cases. Conference preparation, therefore, usually involves learning clinical radiology, pathology, literature review, familiarization with the hospital information system, and creation of electronic presentations. By preparing and presenting these conferences, all residents become facile in utilization of electronic media and public speaking.

Research Activities

Resident participation in clinical or basic science research is required, with all residents expected to submit at least one research project for presentation at a national meeting and to have prepared one manuscript for publication (at some time during their residency).

Support by the Program Director and Associate Program Director
Residents are generally discouraged from participating in research during the first year of residency. At this stage of their careers they are encouraged to read and learn about clinical radiology. Additionally, many residents have recently moved to the area and it is our feeling that some time is required before the residents and their families have fully adjusted to living in Ann Arbor. The Program Director or Associate Program Director meets with all residents at the end of their first year and strongly encourages each of them to become involved in a research project. Residents may wish to find faculty members with whom to collaborate on their own. They work closely with a large number of faculty members who are actively involved in many different research projects, ranging from basic science to clinical studies, all of whom are very enthusiastic about the opportunity to collaborate with residents. However, should a resident be uncertain about how to begin their research activity, the Program Director and/or Associate Program Director will assist them in finding a research mentor.
 

Instruction
Research conferences (previously described) serve to teach residents the basic principles of research design and of data analysis, as well as to introduce residents to the individual clinical and basic science researchers throughout the department

Research Time
Residents may spend up to a full year performing basic science or clinical research, as long as strong evidence is provided to the program director justifying such an assignment. Most residents pursuing this course will require external grant funding to support their extensive research time. Three residents in the past few years have pursued research over 6-12 months of their residency. Two of these residents were MD-PhDs and all were grant funded.

Information and Imaging Retrieval Support
The Radiology Department provides extensive support for resident research activities. The department’s computer group provides database searches of years of radiologic reports. The hospital wide CareWeb information system allows for direct access to medical records from any computer in the hospital. Clinical cases’ images can be easily accessed via the radiology information system, or retrieved from the file room or the PACS system.

Financial Support
The Department of Radiology has seed grant money available to encourage preliminary research projects. The Radiology Department enthusiastically covers incurred travel expenses (up to $1,500) for residents who present their research at national or international meetings. Any money remaining after travel expenses are paid is added to the resident’s individual book fund.
 

Personnel Support
The department includes a basic science division whose faculty members are available for consultation and whose equipment is available for shared use. Many additional research facilities are available throughout the Medical School and University. The department employs a number of research assistants who can help with paperwork and other tasks. The department has its own media services, with individuals in these areas available to facilitate resident preparation of electronic presentations and hard copy manuscripts. One of the department secretaries is specifically assigned to assist the residents in their research endeavors.
 

Literature Support
Most research of the medical literature is now performed electronically. However, textbooks, CDs, and DVDs for clinical learning, as well as for gaining background knowledge for a research project, remain popular. These materials are available in the resident library administered by the program coordinator and can only be signed out by residents and fellows. Included are many up to date favorite titles, preferred by residents and selected by residents. New materials are added regularly and the library is very well used by residents.

General Competencies

The residency training program has implemented a system by which residents are taught and evaluated in each of the six general competencies (many of which involve non-interpretive skills).ACGME requirements are such that instruction and evaluation must be formalized into the six general competencies. It has long been our belief that the overall mission of our radiology residency training program is to produce radiologists who are knowledgeable and compassionate care givers, who can communicate articulately and enthusiastically to patients and other health care workers, who are professional in demeanor at all times, who have developed the tools to keep learning and growing throughout their careers, who understand their role and who are enthusiastic participants in the health care system. Resident instruction in these areas of medical knowledge, patient care, interpersonal skills, professionalism, practice-based learning, and systems-based practice is an integral part of the radiology curriculum.

REV: 6/2007 jb

[Introduction]   [Clinical rotations]   [On-call experience]

[Conferences]   [Research Activities]   [General Competencies]