The Radiology residency provides four years of training in Diagnostic Imaging. Appointments are held jointly as a resident at the Beth Israel Deaconess Medical Center (BIDMC) and as a clinical fellow at Harvard Medical School (HMS). There are ten residency positions available annually.
The Beth Israel Deaconess Medical Center, a major teaching hospital of Harvard Medical School, is a level-one trauma center with 700 beds. It is located in the Boston Longwood Medical Area, along with Harvard Medical School, Boston Children's Hospital, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Joslin Diabetes Center. The West Campus (formerly New England Deaconess Hospital) and the East Campus (formerly Beth Israel Hospital) and outpatient center (Carl J. Shapiro Clinical Center) are across the street from one another.
With a central role in clinical service, teaching, and research, the Radiology Department performs over 400,000 radiologic examinations each year. The department provides radiography, CT, ultrasound, MRI, nuclear medicine, mammography, angiography, and interventional radiology services to both the medical center as well as our affiliated health care facilities. A radiology research and animal laboratory is housed adjacent to the Radiology Department. There are over 70 full-time and part-time clinical diagnostic radiologists, 15 additional research faculty members, plus 25 clinical and post-doctoral research fellows. All residents, fellows, and faculty have appointments at Harvard Medical School. All radiologic studies are interpreted under the supervision of staff radiologists. Our nuclear medicine program is a part of the
Joint Program in Nuclear Medicine at Harvard Medical School.
Our department prides itself on being supportive of its residents and places strong emphasis on the quality of teaching-both in didactic lectures and in individual case-based teaching.
Training Program Curriculum
With the advent of recent changes in residency training, the curriculum has recently been revised so that residents undertake a course of study which will permit them to obtain expertise not just in clinical subspecialties but also in other key areas such as research, education, global health, quality improvement, and health policy. Radiologic physics has been integrated into daily didactic sessions. In addition, many didactic sessions utilize audience response technology, video-recording, and iPad2 technology.
There are nine formal sections in the department: abdominal imaging, breast imaging, cardiovascular and interventional radiology (CVIR), MRI, musculoskeletal imaging, neuroradiology, nuclear medicine, ultrasound, and thoracic imaging. Most non-angiographic interventional procedures are performed by the respective services. Residents rotating through these sections are provided with reading suggestions and material. Academic rotations are made up of thirteen 4-week blocks annually. At the end of each rotation residents receive written evaluations and have the opportunity to evaluate the staff.
First year rotations emphasize fundamentals and common radiologic examinations in preparation for inpatient and emergency department responsibilities. Prior to taking call, all first year residents rotate through abdominal imaging, breast imaging, emergency radiology, fluoroscopy, musculoskeletal imaging, neuroradiology, nuclear medicine, thoracic imaging, and ultrasound.
During the second year, residents continue to gain experience in these sections, performing and interpreting more advanced examinations and interventions as their levels of expertise increase. Additional rotations in more specialized topics occur throughout the second through fourth years, including interventional radiology, MRI, head and neck imaging, and pediatric radiology. In addition, all residents participate in a two-week rotation in quality assurance which provides them with essential skills for eventual board re-certification.
"Away" rotations during the second and third years of training include:
- Three months of training in pediatric radiology at the Boston Children's Hospital during the second year.
- Four week program in radiologic-pathologic correlation at the
Armed Forces Institute of Pathology (AIRP) sponsored by the American College of Radiology in Silver Springs, Maryland during the third year.
- One month rotation at the Massachusetts Eye and Ear Infirmary in head-and-neck radiology during the third year.
Upon completion of the second year of residency training, residents select an area of academic focus for their fourth year which will guide choices for the 3-month mini-fellowships and the other two months of elective time.
Our Unique Educational Tracks
Currently, six tracks are offered:
- Global health
- Quality improvement
- Health policy/health economics
Each of these tracks has specific curricular offerings and educational goals. Most of the tracks are linked to specific educational endeavors. For example, a resident selecting the global health track will enroll in the global effectiveness curriculum offered by the Harvard School of Public Health and will spend time abroad providing clinical radiology services and undertaking a global health project. A resident selecting the education track will pursue advanced training in educational theory and adult learning by participating in the Harvard Macy Program for Physician Educators and undertake an educational project based at BIDMC or Harvard Medical School. A resident choosing the research track will participate in grant writing workshops and delve deeply into a research project of their choice.
No matter which career track, the expectation is that every resident will have the opportunity to undertake a substantial project during residency that will culminate in presentation at a national meeting and/or publication [see resident/faculty accomplishment section for further details]
A representative curriculum for the first three years is composed of the following 4-week blocks:
- Abdominal imaging: 3 blocks
- Angiography: 3 blocks
- Breast Imaging: 2 blocks
- Cardiac imaging: 1 block
- ED/Night Float: 3 blocks
- Head and Neck Imaging: 1 block
- MRI: 2 blocks
- Musculoskeletal: 3 blocks
- Neuroradiology: 3 blocks
- Nuclear medicine: 3 blocks
- Pediatric Imaging: 3 blocks
- Thoracic radiology: 3 blocks
- Ultrasound: 3.5 blocks
- QA rotation: 0.5 block
- AIRP: 1 block
- Vacation: 3 blocks
A representative curriculum for the fourth year of residency would be:
- Mini-fellowship 1: 3 blocks
- Mini-fellowship 2: 3 blocks
- Elective: 2 blocks
- Breast Imaging: 1 block
- Nuclear imaging: 1 block
- ED/Night Float: 1 blocks
- Departmental Coverage: 1 block
- Vacation: 1 block
Resident teaching conferences occur daily between 7:30-9:00 AM. Many of the sections provide their sessions in weekly blocks in an effort to provide residents the opportunity to focus in one area for a period of time. Overall, these sessions are evenly divided between "hot seat" case review and didactic lectures. Many of the lectures utilize audience response technology. In addition, we recently integrated iPad2 technology into the educational program. Residents are expected to attend these morning conferences, with coverage for clinical services provided by staff and fellows during these times.
The radiology residency begins with a one-week course for first-year residents to learn some essentials of radiology and common plain-film diagnoses. From the first day, residents learn how to approach cases and how to communicate the important radiologic findings.
Radiology physics has recently become a longitudinal course fully integrated into the morning conferences. In addition, the Department continues to pay for residents to attend a local physics board review course between the second and third years of training.
Weekly multidisciplinary and specialty conferences are conducted in the Radiology Department in conjunction with the cardiology, gastroenterology, urology, neurology, surgical oncology, orthopedic surgery, cardiothoracic surgery, and pulmonology services. Active participation of residents in many of these conferences serves as an optimal way to understand how imaging findings are integrated into patient management. This experience translates into stronger clinical radiologists. Daily teaching sessions are also held in the Division of Nuclear Medicine.
BIDMC has a weekly grand rounds series that offers a wide variety of radiologic imaging. Approximately once a month, we invite a visiting professor to our department to give a formal grand rounds lecture and a resident board review. In addition, some of our clinical faculty and faculty from other departments provide lectures. Finally, once a month, more senior residents present interesting cases from the Department, which offers a great opportunity to develop teaching skills.
As befits any great medical city, many conferences are held at other local institutions. Meetings of the New England Roentgen Ray Society are held bi-monthly on Friday afternoons. Staff coverage during these times is provided so that residents may attend these meetings. Seminars and lectures in radiology are also held at adjacent Longwood Medical Area institutions. Other major medical centers in the city are the Brigham and Womens Hospital, Boston Medical Center, Massachusetts General Hospital, and Tufts/New England Medical Center. Many national meetings and post-graduate courses are held at local hotels.
Residents may attend one of the major national radiologic meetings at the expense of the Department. With the approval of the department chair, residents making presentations may attend additional meetings with expenses paid.
Residents regularly teach medical students taking the core clerkship in diagnostic imaging and participate in teaching anatomy and physiology to student technologists.
The department maintains a radiology textbook and journal library, together with large collections of teaching films, including the complete American College of Radiology hard copy film library and CD-ROMs. The residency has annual subscriptions to StatDx and E-anatomy. In addition, with recent integration of iPad2s into the residency, there are a growing number of digital teaching resources which have been developed by both residents and staff. The Harvard Medical Library is a short walk from the medical center but can be easily accessed on-line through the hospital portal.
The department prides itself on being supportive of its residents and places emphasis on their participation in decisions affecting the educational program. There are two Chief Residents who represent the resident at weekly residency meetings and at the monthly departmental faculty meetings. Many other residents also become involved in a variety of committees in the department.
Call Duties - Weekday, Nights, and Weekends
Residents' on-call duties start at the beginning of the second year and extend through the first half of the fourth year. Call duties are currently minimal during preparation for oral boards, and we plan to shift this period of light call to accommodate the new ABR exam structure to the end of the third year. Our residency program meets all ACGME duty hours' requirements.
Weekday call is covered strictly with a float system. There are three different float shifts, designed to provide timely interpretations of both studies originating in the Emergency Department as well as urgent inpatient studies. Based on our current complement of residents, any single resident can expect to cover a total of approximately 16 weeks of float, spread over the second, third and fourth years. The current call system is resident-designed and all call is scheduled by the chief residents. Current float shifts include:
- Evening inpatient call, based on our East campus but covering both West Campus and East Campus inpatients from 4 pm - Midnight, Monday-Friday
- Evening ED call, based on the West campus: 3 pm - Midnight, Monday-Friday
- Overnight call ("Night Float"), based on the West Campus, covering ED patients until midnight and both ED patients and inpatients thereafter. Shifts begin at 9pm on Saturday and Sunday and at 10 pm Monday -Friday, ending in the morning with readouts that begin at 7:30 AM. Typical departure time is between 9 and 10 AM. [Note: to accommodate new duty hour rules prohibiting more than 6 consecutive overnight shifts, the Saturday overnight shift is now covered by the resident having just completed a week of Evening inpatient call.]
Weekend daytime call is assigned separately from the float system. Saturday and Sunday day shifts run from 9 am - 9pm, with residents assigned to both the East and West Campuses, such that four weekend day shifts exist each weekend. A similar system is used to cover hospital holidays. Currently, all weekend and holiday call is covered by our second and third year residents, resulting in an average of 11.4 weekend day shifts per resident, per year.
When rotating at Children's Hospital Boston and when on the Interventional Radiology rotation, residents participate in those call pools and do not participate in the regular call pools.
Emergency Department (ED) Coverage
Daytime ED coverage is incorporated into our routine rotation schedule. First years begin to rotate through the ED several months into the residency after having been exposed to the major modalities in the non-emergent setting. Additional daytime ED coverage in the beginning of the year is provided by upper level residents who return to the ED, typically for 2 week rotations.
The "Call Experience"
All residents will agree that being on call is challenging, but it is also the time when residents really begin to trust their education and judgment and learn to work independently. Radiology residents in the ED and on inpatient call always have support from more senior radiologists. In-house attending coverage extends every day until 11 PM. After this time, residents are the only radiologists routinely in-house, though back-up exists both in the form of fellows and attendings who can review images from outside the hospital via our web-based PACS system and provide consultation as needed. Additionally, during the evening hours, the presence of two on-call residents is invaluable. The East and West residents frequently consult each other on difficult cases, and whenever possible help each other provide timely interpretations during periods of high volume.
As a Level 1 trauma center, we have quite a diverse patient population, varying from indigent patients to transplant patients to trauma victims. While difficult at times, the call experience helps residents hone their skills, learn their deficiencies, and develop the ability work efficiently while under pressure. Our graduating and former residents frequently note that the confidence gained during their time on call at BIDMC was essential in taking on increased responsibility as a fellow or attending.