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1 Department of Radiology, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Rd., NE, Atlanta, GA 30322.
Received July 1, 2004; accepted after revision July 1, 2004.
Address correspondence to K. H. Vydareny.
The simplistic answer is, "It is required." Since July 2002, the Accreditation Council on Graduate Medical Education has required that all residency programs provide learning opportunities for each resident to acquire "specific knowledge, skills, behaviors, and attitudes" of the six general competencies (i.e., patient care, general medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice) and must assess the resident's learning of these competencies in their evaluations. [2] Site surveyors visiting radiology residencies before the program is reviewed by the Residency Review Committee are now asking program directors about their teaching of these competencies in their didactic programs and, beginning July 2006, will require evidence that the programs are making improvements to their teaching of these issues using data-driven outcomes measurements. The teaching of ethics can be considered one of the issues to be assessed and learned as part of the "professionalism" competency.
However, the real reason to teach these issues to our residents lies much deeper than meeting a requirement by an outside organization. Diagnostic radiology residency training programs should seek to train physicians, not just image interpreters. As such, our residents need to learn how to interact with patients and other physicians, to communicate the imaging findings, and to answer questions regarding patient treatment, appropriate sequencing of examinations, and so forth, as well as to "read the images."
The naïve cynical observer might question whether there are any important ethical issues to be addressed in diagnostic radiology. After all, many issues (e.g., end-of-life care or telling the patient and his or her family about a terminal condition) are handled by the patient's clinician and not by the radiology consultant. However, on looking deeper, we realize that ethical issues definitely arise during our daily practice, some of which are discussed in the article. How does one convey to the patient or physician that an interpretive error was made? Should one perform imaging procedures that are not proven but which may be lucrative to the radiologist? Should one perform an imaging procedure on a patient when the result will not change patient treatment? Can a radiologist make certain that a patient's consent is truly "informed"? Should patients who undergo screening examinations give informed consent? Should we communicate our findings directly to the patient or only to his or her clinician? What if we cannot locate the clinician?
A survey performed by the authors of the article notes that nearly half of the responding programs used the American College of Radiology (ACR) ethics videotape, recorded several years ago, as the only source of ethics training for residents. The tape is an introduction to ethical principles and is a free-ranging, nonstructured discussion with residents, a lawyer, and a bioethicist about a focused issue (misinterpretation of an earlier mammographic finding causing a delay of diagnosis discovered during the next annual examination). As the moderator of this tape for the ACR, I know that it was not meant to serve as the only discussion of ethics for residents, but merely as a beginning point (just as a 1-hr discussion of business issues will not give him or her enough knowledge to be the business manager of a busy radiology department).
Some residency program directors have embraced these competencies and are addressing these issues. Others have yet to begin and do not know quite where or how to start. Program directors through the Association of Program Directors in Radiology can help each other and thus help their residents master these competencies. The preceding article describes how one department has dealt with the teaching of ethics. There are very likely countless equally effective ways to teach and discuss the subject. Like the ACR tape, this article is a beginning, not the only way and definitely not the only end product. The important point is that our residents need to discuss and think about ethics issues in nonthreatening ways before a real, and not theoretic, need to do so arises. We, the faculty, can give a perspective based on experience and can learn from the residents as well. We owe our residents and our patients that much!
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  M. Janower Ethics Training for Radiology Residents Am. J. Roentgenol., February 1, 2005; 184(2): 701 - 701. [Full Text] [PDF]
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