Modernizing the Radiology Residency Curricula

Are we training tomorrow’s radiologists to succeed in yesterday’s health systems?


July 2015

The field of radiology is in a state of flux. Changes in the financial and political landscape, along with numerous technological innovations, threaten to transform how radiology has been traditionally practiced.

While imaging is poised to maintain a central role in the future of health care, the role of the radiologist and the residency programs that train them, are far less certain. As the fee-for-service model gives way to quality and cost-savings models, radiologists will be forced rethink their place within the health care system and develop novel ways to provide service and value.

Unfortunately, many radiology residency programs have been slow to adapt to the realities of the changing health care environment, putting the futures of radiology residents in jeopardy. Current curricula cater to practice paradigms that are likely to be replaced, such as the fee-for-service reimbursement model and value systems that rely wholly on image interpretation. The ACR has been on the front lines in advocating for the implementation of Imaging 3.0 in radiology practices, providing the necessary tools to deliver value beyond image interpretation. At the same time, residency programs also need to broaden their education and include the consulting, leadership, business, and technological skills that will be necessary to compete in the health care environment of the future.

Residency programs are focused on the present, with residents hired to simply churn through imaging cases. Residents are primarily taught the skills of traditional image interpretation. If the specialty is to thrive in the future, its training programs need to be forward thinking. Residency programs should be focused on preparing residents for the radiology of tomorrow. In the new health care paradigm, the number of cases read will be less important than national quality measures and cost savings by way of appropriate resource utilization. While image interpretation is and will likely remain the core and centerpiece of radiology, radiologists need to expand their skills to meet new demands.

One of the most important skills radiologists will require is that of clinical consulting, which encompasses both the science of radiologic expertise and the art of customer service. Residents need learn how to provide excellent, timely, and actionable information to referring clinicians in a manner that embeds radiologists within the clinical decision-making process. Several residency programs have already created innovative clinical rotations that integrate radiologists into the clinical floor or ICU teams. A dedicated resident that provides formal consults for clinical teams regarding image interpretation or utilization may also be beneficial. These types of programs allow radiologists to provide value by being consultants at the point of care and offering vital radiologic advice regarding appropriate imaging utilization and radiation exposure management beyond image interpretation.

Leadership skills will also be important, as radiologists will be required to justify their value to accountability care organizations and hospital boards in order to receive fair compensation. Residency programs should help residents into leadership roles by encouraging membership in departmental and hospital committees that will allow for the increased visibility of radiologists within the hospital and health care system. Residents should also be encouraged to participate in national leadership organizations such as the ACR and AMA.

The educational curriculum and lecture series provided by residency programs should also adapt to provide a more formal business curriculum. Residency programs need to develop comprehensive and sustained curricula that deal with all aspects of the business of radiology. Residents need to understand how to develop a practice by building a foundation in finance, operations, and marketing. Residents will be required to compete with large hospital groups, teleradiology firms, and other practices. We need the business skills required to succeed.

Lastly, disruptive technologies will threaten the status quo. Machine learning and image interpretation algorithms are likely to have an expanded role in the future of radiology, and certain technological processes are likely to replace radiologists in at least some capacity. This will require radiologists to work alongside image interpretation algorithms and clinical support mechanisms. A strong foundation in technology and its limitations will be vital and will allow residents to develop the skills necessary to innovate and implement creative solutions to existing and developing problems.

The future for radiologists is uncertain. Health care reform, new reimbursement models, and technological advances guarantee to transform the field of radiology and disrupt traditional practice paradigms. In order for radiologists to provide value in the future, residency programs need to be modernized and retooled in anticipation of future realities. Consulting, business, leadership and technological skills beyond image interpretation will be required for radiologists to successfully provide value and compete in the future. Radiology residency programs need to adapt to provide these skills — and quickly.



By Shimon M. Aronhime, MD (@ShimonAronhime)

Note: This blog was originally posted at Dr. Aronhime's personal blog. 

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