Radiology Education

Overview

The Radiology residency provides four years of training in Diagnostic Imaging. Appointments are held jointly as a resident at Beth Israel Deaconess Medical Center (BIDMC) and as a clinical fellow at Harvard Medical School (HMS). There are eight diagnostic radiology residency positions available annually.

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. There are over 69 full-time and part-time clinical diagnostic radiologists, 13 additional research faculty and technical/adjunct staff, plus 35 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 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 learning.

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 that 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.

There are nine formal sections in the department:

Most non-angiographic interventional procedures are performed by the respective services and a procedural “mini-fellowship” is available to cement this strong foundation. Residents rotating through these sections are provided with reading suggestions and material. 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 first through fourth years, including interventional radiology, body MRI, head and neck imaging, and pediatric radiology. In addition, all residents participate in our Friday morning practice management and leadership curriculum that provides them with essential non-interpretive skills.

"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.
• One month of training in head and neck radiology at the Massachusetts Eye and Ear Infirmary during the third year.
• One month program in radiologic-pathologic correlation at the American Institute of Radiologic Pathology (AIRP) sponsored by the American College of Radiology in Silver Spring, Maryland, during the third year. Funding for lodging and travel is provided by the residency.

Upon completion of the second year of residency training, residents select an area of academic focus for their fourth year that will guide choices for the 3-month mini-fellowships and another 1-2 months of elective time. In addition, each fourth year resident participates in a week-long online informatics course focused on the informatics systems that underlie the daily workflow in radiology.

Our Unique Individualized Educational Concentration Curriculum

In the past and currently, our residents have chosen to pursue augmented training in the following:

Residents, typically in their fourth year will have ample opportunity to further their training in their specific area of interests. For example, a resident interested in global health can enroll in the global effectiveness curriculum offered by the Harvard School of Public Health. In the past, some residents have spent up to one month abroad providing clinical radiology services and undertaking a global health projects. A resident dedicated to education may be able to pursue advanced training in educational theory and adult learning by participating in the Harvard Macy Program for Physician Educators or the BIDMC Academy CME Educator’s course and undertake an educational project based at BIDMC or Harvard Medical School. Residents interested in furthering their ability to pursue independent research can delve deeply into research projects of their choice, with mentorship and dedicated time to write or conduct their experiments. Three of our residents in the past five years have been successful at securing grant funding such as RSNA grants. For residents interested in quality improvement, multiple departmental, hospital, regional and national opportunities are established, for example, the radiology resident “ideas” committee, the BIDMC house-staff quality improvement council (HSQIC) and the Massachusetts Radiological Society Quality and Safety Committee. Additionally, previous residents with interest in this aspect of radiology have developed data-driven quality improvement projects, participated in a quality panel reviewing abstracts at RSNA and developed the ACR RadImprove peer learning platform.

Regardless of their specific interests, 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:

A representative curriculum for the fourth year of residency would be:

Education

Resident teaching conferences occur daily Monday-Thursday, between 7:30 - 9 a.m. Many of the sections provide their sessions in 1-2 week 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. Some of the lectures utilize audience response technology. Residents are expected to attend these morning conferences, with coverage for clinical services provided by staff and fellows during these times.

On Fridays, sessions cover practice management, leadership and non-interpretative skills, many of which are covered on the core examination and others of which are important to future success in practice.

In addition, the radiology residency begins with a one-month “bootcamp” course for first-year residents to learn essentials of radiology as we recognize that residents who enter our program come to us with varied experiences in medical school. Right from the first day on clinical service, residents learn how to approach cases and how to communicate the important radiologic findings.

Radiologic physics is fully integrated into the morning conferences with dedicated sessions given by both physicists and practicing radiologists. In addition, the Department continues to support residents to attend a local physics board review course during the third year of training.

Weekly multidisciplinary and specialty conferences are conducted in the Radiology Department in conjunction with these services:

Active participation in many of these conferences serves as an optimal way for residents to understand how imaging findings are integrated into patient management. This experience translates into stronger clinical radiologists. Also, daily didactic sessions and weekly journal clubs are held in the Division of Nuclear Medicine.

BIDMC has a weekly grand rounds series that covers a wide variety of topics related to radiologic imaging. Approximately once a month, there is an invited visiting professor to the department who gives a formal grand rounds lecture. 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 and presentation skills as we all participate in peer coaching during these sessions.

Boston is an outstanding city to train in Radiology; many local, regional, and national conferences are held locally. For example, the New England Roentgen Ray Society holds bi-monthly resident conferences on Friday afternoons in which selected faculty from regional institutions including BIDMC, Brigham and Women's Hospital, Boston Medical Center, Massachusetts General Hospital, Brown University, Dartmouth, Maine Medical Center, and Tufts/New England Medical Center give outstanding lectures. BIDMC Attendings cover the clinical services during these times so that residents may attend these meetings.