Are the changes beneficial or even needed?

December 1, 2008

The wide-ranging debate within the pages of two of radiology's leadingpeer-reviewed journals includes proposals for yet another dramaticapproach to reforming the residency and testing process: cutting residencyto three years and moving clinical training to a year of fellowship.

The wide-ranging debate within the pages of two of radiology's leading peer-reviewed journals includes proposals for yet another dramatic approach to reforming the residency and testing process: cutting residency to three years and moving clinical training to a year of fellowship.

Writing in the November issue of the American Journal of Roentgenology, three researchers with the American College of Radiology recommend trimming residency training to three years, saying that includes the time necessary to complete required clinical rotations. Graduates could then take fellowships in their planned subspecialties, according to the suggestion by Drs. Jonathan H. Sunshine, Rebecca S. Lewis, and Mythreyi Bhargavan. Following residency, there should be an examination covering the whole of radiology, they said.

The novel idea was also proposed earlier by current and former officials of the American College of Radiology, ACR vice president Dr. N. Reed Dunnick and Dr. Ronald Arenson, chair of the radiology department at the University of California, San Francisco.

"Residency could be shortened to three years, which would be sufficient to provide a solid basis on which to build subspecialty expertise," they wrote in the Journal of the American College of Radiology (2006;3[6]:389-393). In their proposal, the clinical year would be moved back into a required fellowship program.

Dr. Dennis Balfe, chair of the American Board of Radiology's certification committee, pointed out that the Residents Review Committee is responsible for training modifications and noted the training schedule used to be a three-year residency followed by two-year fellowship. But he questioned whether the change is pragmatic now.

"I always thought it was a negative recruiting tool because what if everybody wanted to go into the same specialty in the same year?" he said. "As an institutional decision, it sounds like it might be a nonstarter." Other criticisms targeted what should be covered in the new certification exam and questioned whether the overhaul is needed at all.

The ACR researchers say plans to have the new exam cover three subspecialties is insufficient; at least five fields should be tested, based on actual practice patterns, they said.

Writing in the May edition of the AJR, associate editor Patrick M. Colletti questioned the basis for the revisions.

"If the board format is not broken, then why fix it?" he asked.

The current oral exam, administered by 10 experts, allows a comprehensive assessment of a candidate's knowledge and communication skills that no multiple choice test can possibly duplicate.

Colletti also argued that delaying the certification exam for 15 months will limit the ability of graduates to enter the workforce right away.

"Graduating radiologists without board certification will have substantially reduced options for employment," he said.

-DD