| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Commentary |
1 Chair, Radiology RRC, 2004-2006. Emory University School of Medicine, 1364
Clifton Rd., NE, Atlanta, GA 30324.
2 Chair, Radiology RRC, 2007-2009. Albert Einstein College of Medicine and
Montefiore Medical Center, Bronx, NY 10467.
The opinions expressed in this policy brief are those of Kay Vydareny and
E. Stephen Amis, Jr.; they do not necessarily reflect the viewpoint or
position of the editors, reviewers, or publisher of the American Journal
of Roentgenology. Readers are encouraged to submit letters to the editor
in response to this Commentary.
Keywords: accreditation • residency program • Residency Review Committee • RRC • training program
We are pleased to be able to clarify some issues regarding the Radiology RRC (Residency Review Committee). The RRC's mission is accreditation of training programs, a process designed to ensure that radiology residents are appropriately trained to practice our specialty. As such, we review each core residency program and the associated accredited subspecialty programs in abdominal radiology, musculoskeletal radiology, cardiothoracic radiology, nuclear radiology, pediatric radiology, neuroradiology, and interventional radiology every 2 to 5 years. These reviews are preceded by the submission of a program information form (PIF) and a visit by an Accreditation Council for Graduate Medical Education (ACGME) site visitor, who spends time with the chair, program director, faculty and residents, as well as nonradiology physicians, verifying the information in the PIF and asking probing questions as well as viewing the imaging facilities.
The RRC is composed of 10 members, three appointed by the American Board of Radiology, three by the American College of Radiology, three by the Radiology Section of the American Medical Association, and a resident member elected from nominations by these groups. The executive director of the American Board of Radiology is an ex officio, nonvoting member. The RRC at this time includes a current program director, several former program directors, several department chairs, and a private practitioner; all members have an interest and expertise in resident education. The resident member serves a 2-year term, while the others serve 6-year terms. Members of the RRC and their affiliations are listed on the ACGME Web site (www.acgme.org).
The RRC must perform a revision of the program requirements every 5 years, according to ACGME bylaws. The present cycle of revision began over a year ago, in the fall of 2005, when an additional 2-day meeting of the RRC was scheduled for this discussion. Our goal was to simplify and update the requirements as well as to incorporate the six general competencies and, in conjunction with all of the other RRCs, to become more outcome based (i.e., rather than have the program state how it plans to educate the resident, we ask the program to evaluate the outcome of this training). The proposed requirements were presented at both the 2005 and 2006 RSNA and the 2006 Association of University Radiologists/Association of Program Directors in Radiology (AUR/APDR) meetings; comments generated by those presentations were discussed at two subsequent RRC meetings. The proposed program requirements as published on the ACGME Web site are thus the fourth draft of these proposals. After the 6-week comment period required by the ACGME, the RRC will address each individual comment, either agreeing (and thus making changes to the proposed requirements) or disagreeing (and leaving the proposed requirements as is). The "final" version will be presented to the Program Requirements Committee of the ACGME in February 2007 and must be accepted by this committee and by the ACGME Board before they go into effect.
David Larson [1] has discussed many of the substantive changes in the proposed program requirements. Clearly the most hotly debated is the proposal to delay independent call until after a resident has had at least 12 months of radiology training. The 6-month delay that it replaces was written into the requirements in the 1990s. Until then, residents could begin to take call as early as their first day of radiology residency! The proposed change is recommended in the spirit of improving patient safety, to bring radiology into closer alignment with supervisory requirements of other major specialties, and also because a better trained resident will be able to function more confidently in a complex clinical environment, which is very unforgiving of error. This view is validated by Leach and Philibert [2], senior administrators of the ACGME, who wrote "...residents early in their training are by definition not yet competent. Their relative inexperience makes them error-prone and potentially dangerous to patients and themselves if they are functioning alone and in the absence of supervision." Anesthesiology, emergency medicine, and obstetrics and gynecology all require the presence of on-site faculty supervision at all times. Internal medicine and neurological surgery require experienced residents or faculty on-site for supervision of first-year residents. Review of the rather limited literature, which addresses the training level of residents whose performance is being measured, indicates that the level of training can have a significant effect on the rate of disagreement between the resident's preliminary interpretation and the faculty member's final reading [3, 4]. We agree that call responsibilities are intensive learning experiences for the resident and appreciate that smaller programs will have more difficulty than larger ones in accommodating this change. In summary, however, we believe that the current emphasis on patient safety outweighs the coverage issues in recommending this change.
There has actually been no change in the requirement for radiology/pathology correlation. The RRC believes that such correlation remains important in a radiologist's education. The statement that there must be radiology/pathology conferences for those who do not attend a formal extramural pathology course was merely moved from a stand-alone statement to its inclusion in a list of the requirements for the general didactic portion of the core curriculum, where we felt it belonged, along with the other requirements for didactic education in molecular imaging, radiation biology, etc. There is no question that the formal course at the Armed Forces Institute of Pathology (AFIP) is the highlight of many residents' education in pathology; a program's decision to send its residents to this course would fulfill the requirement but is, of necessity, based on many factors, some of which are financial.
Changes in tracking resident learning derive from principles of adult education that note that learning is student- and not teacher-driven. Thus the resident needs to develop a learning plan, document learning activities, and use formative evaluations to improve. These activities will prepare residents for the life-long learning activities they will need as part of their maintenance of certification program throughout their professional lives.
In support of this concept, the RRC felt that the contents of the newly required learning portfolio, which is an ACGME initiative, should be well-defined, to prevent confusion on the part of residents or program directors. Therefore, for each of the general competencies, specific required documentation is listed.
The requirement that each resident must engage in a scholarly project is in keeping with the ACGME common requirements. This project may be laboratory research, clinical research, or an analysis of disease processes, imaging techniques, or practice management issues. An appropriate project involving the last of these would suffice for both engagement in a scholarly project and undergoing a learning activity involving systems problems.
The requirement for a radiology library and an institutional teaching file in every department was indeed deleted. The RRC is requiring instead the availability of 24-hour high-speed Internet access. We feel that this reflects widespread availability of radiology images and literature available on the Internet and the reality of education in the 21st century. Any department that feels that a radiology library and institutional teaching file are important for their residents should indeed continue with those activities; they are not proscribed, merely not required.
We welcome the opportunity to make certain that the radiology community is aware of these proposed changes, and thank David Larson for his interest in them. By the time this article is published, the comment period on these requirements will have expired. We certainly hope that all interested parties feel they had an opportunity to understand and to comment on these changes. The final document will be available as soon as it is approved by the ACGME. Once the revision of the program requirements is complete, we will turn our attention to updating the PIF, with the intent to make it shorter and less onerous for program directors. We are pleased that the radiology community shares our interest in the education of our residents—since today's residents are tomorrow's colleagues—and well-trained residents will help to ensure the future of our specialty.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Ganguli, M. Camacho, C.-S. Yam, and I. Pedrosa Preparing First-Year Radiology Residents and Assessing Their Readiness for On-Call Responsibilities: Results Over 5 Years Am. J. Roentgenol., February 1, 2009; 192(2): 539 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Amis Jr. New Program Requirements for Diagnostic Radiology: Update and Discussion of the More Complex Requirements Am. J. Roentgenol., January 1, 2008; 190(1): 2 - 4. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
