The most exciting aspect of Radiology as a field is that it is constantly evolving and, as a result, residency training must keep pace. Despite being at the forefront of medical technology, most residencies continue to conform to an apprenticeship model of medical training. At Stanford, we are laying plans to move a significant portion of radiology resident learning away from the conventional apprenticeship model to a model mimicking airline pilot training: centered on controlled, pre-selected, and directed cases. Deliberate, or purposeful practice as it is known in the science of developing expertise. This is easier said than done! We have begun piloting new ways of augmenting our day-to-day learning in different sections: musculoskeletal imaging has a checklist of diagnoses and joints that are expected to be discussed over the course of a rotation; breast imaging has an enriched screening dataset with pathology-proven diagnoses; thoracic imaging has developed a month-long curriculum of cases that are viewed by residents and discussed as if they are de novo cases and tracked over the course of the month to ensure broad and representative exposure. In addition, we are fortunate to be able to experience a large (and growing) number and variety of de novo cases, given the growing practices associated with our residency, which include community- and county-hospital practices, quaternary care, and now population-based health. These are just a few examples of how we are moving toward a more deliberate residency training experience.
In that spirit, we moved to a block-conference curriculum two years ago. Residents from the various clinical sites meet together weekly for a five-hour block conference at Stanford, with lunch provided by the department. The sections have been working on a revised curriculum to maximize the benefit of this type of exposure. This format has the added benefit of bringing our residents together on a regular basis outside of the clinical environment and to date has been a very popular change. This past year we began a peer learning component of the conferences, which has quickly become a favorite.
During the first three years of residency, trainees rotate through all clinical subspecialties of radiology including pediatrics, emergency radiology, genitourinary, gastrointestinal, chest, musculoskeletal, vascular/interventional, neuroradiology, cardiovascular, mammography, ultrasound, body CT, fetal imaging, and body MRI. Residents spend the majority of time at Stanford Hospital and associated outpatient clinics, with additional rotations at the VA Palo Alto Health Care System and Lucile Packard Children’s Hospital. Our residents also rotate to the Santa Clara Valley Medical Center for rotations in mammography and emergency radiology. All residents have the opportunity to take a four-week subsidized elective at the Registry of Radiologic Pathology at the American Institute for Radiologic Pathology (AIRP) in Washington, D.C.
We have continued to improve the core radiology clinical training experience in order to expand the ability of our fourth-year residents to experience early clinical subspecialization of their choice, including nontraditional pathways. Some residents have chosen to pursue early subspecialization in a single field such as neuroradiology or interventional radiology. Some have chosen to use this time to enhance several aspects of their clinical exposure, while others have included research endeavors, biodesign, leadership and quality “mini” fellowships during their fourth year.
This year we look forward to our third year of recruitment into the Interventional Radiology residency, and have recently been approved by the ACGME to offer the Early Subspecialization in IR (ESIR) pathway as an option for our incoming diagnostic radiology residents, since many will not definitively know which path within the broad specialty of radiology they want to pursue so early in their training.
Dedicated research time is available to residents over the course of the four years. A dedicated T32 program for interested residents provides for 18 months of research and is timed to maximize the opportunity for an academic career in radiology. Residents are encouraged to participate in a wide range of departmental research efforts, including the Molecular Imaging Program at Stanford and the Radiological Sciences Laboratory / Richard M. Lucas Center. A larger range of departmental research opportunities may be found here. Many of our research minded residents successfully compete for competetive grants, both internal and external. This includes the very popular internal grant offered through the generosity of the Moskowitz family. Residents regularly travel to and present at major national radiology meetings and publish their work in peer-reviewed journals with faculty and financial support from the Department.