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Time for Unprecedented Cooperation Among Residency Programs
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The views that the author expresses in this article are strictly their own and should not be attributed to the American College of Radiology.
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Society is broadly divided into the "haves" and the "have nots." The
"haves," as a group, may be smarter, tougher, more ambitious or none of
the above and just plain lucky. But in a capitalistic society, the image
projected by the "have nots" is rarely motivation enough for the "haves"
to help the "have nots," and the quest for social utopia is perhaps a
disincentive.
Such inequities also exist in the training of radiology residents. This
is a fact that should be stated without shame or fear of political
incorrectness. While most residents get equivalent training in plain
films, body and head CT and US (and, in fact, residents from smaller
programs with less shepherding on call may be more confident in
asserting their interpretation), there is a recognized discrepancy with
regard to training in cardiac imaging, body MRI and advanced
neuroimaging. The reason for this inequity is quite simply the
differences in access to these modalities.
The discrepancy becomes even more significant as radiologists are making
a last-ditch attempt to reclaim cardiac imaging after decades of
self-imposed exile from this field, after the loss of echocardiography.
The American College of Radiology and the American College of Cardiology
will perhaps have their own standards that would stipulate what one
should undertake before reading coronary CTA and cardiac MRI. One's
views of these standards should not detract from the fact that, at
present, the number of programs in which residents are exposed to
cardiac MRI is in the minority.
At first glance it may seem advantageous for someone who graduates with
this additional body of knowledge in their negotiations in this
competitive job market. Such advantage is short-lived. A qualified
radiology resident does not enter the same model of employment as a
qualified MBA student who enters the world of investment banking or
consulting. For the latter, promotion depends on the display of
additional competency. For newly qualified radiologists, their vitality
depends more on the long-term health of radiology than it does on their
individual achievements.
Or put another way, no matter how competent a cardiac imager I become, I
won't be doing much cardiac imaging if radiologists on a whole scale are
not doing much cardiac imaging. And radiologists on a whole scale won't
be doing much cardiac imaging if there are not enough of us trained
adequately. So instead of encouraging the weakest link, it makes sense,
on a purely self-preservation basis, to strengthen the whole link.
This may be achieved in one of many ways. The Resident and Fellow
section of the American College of Radiology is creating a teaching file
of cardiovascular cases. Residents who submit successfully accepted
cases will be awarded $80 in appreciation of their efforts. The RSNA
this year was teeming with refresher courses (free for residents) and,
no doubt, the ARRS will provide a similar repository of educational
material in their upcoming meeting. The Pennsylvania Radiological
Society had lectures on coronary CTA and cardiac MRI in their meeting,
and so will the Philadelphia Roentgen Ray society.
Understandably the current relative paucity of experts in cardiac
imaging will create CME courses in fancy destinations and nice hotels
which, no doubt, will be well-attended by radiologists from private
practice. These courses are generally not attended by residents who,
apart from not being able to afford these events, are likely to benefit
infinitely more from live reading with an attending. Herein lies the
need for a greater degree of cooperation among residency programs than
ever before, to ensure that residents from residency programs who are
not exposed to cardiac imaging are able to rotate through residency
programs that do have the technology, the pathology and the
radiologists.
This cooperation will not be without problems. For one, too many
residents on a particular rotation will make it difficult for the
attending to identify the individual needs of each resident. The
attending may feel, quite correctly, that their primary responsibilities
for training lie toward their fellows and local residents. The local
residents may feel aggrieved that their training is being compromised by
the presence of additional residents. I must add at this stage that, in
my experience, the presence of additional residents (within reason) has
rarely compromised my training. The loss of a few cases is more than
adequately compensated by the stimulating environment provided by the
presence of an additional learned body. The sharing of after-hours work
by visiting residents, in certain circumstances, may provide a basis for
goodwill and a sense of fairness.
The discussion of potential remedies to the above-mentioned problems is
beyond the scope and wisdom of this article. I feel that many of these
are minor inconveniences that should not discourage a concerted effort
to ensure educational uniformity in the training of radiology residents
in the art and science of cardiovascular imaging. I am not advocating
unparalleled unselfishness. I am advocating pragmatic altruism. It is
time for the "haves" to help the "have nots" if the "haves" want to have
more.
Saurabh Jha, MBBS
Resident, Diagnostic Radiology,
University of Pennsylvania
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