Radiology 2010: Learning Curve

Educators hold the future of the profession in their hands - or classroom, more accurately - and they take that responsibility very seriously. In 2010 and beyond, organizations, professors, and program directors are making major changes to the way they teach and guide students through this ever-evolving field.

Residency Programs

Students entering radiology residency programs next year will be the first class to operate under the new structure of the American Board of Radiology's certification examination. Until now, residents were given written physics and diagnostic exams some time between their second and fourth years and an oral exam at the end of their fourth year. The Board's major changes are to have a core exam, administered by computer, 36 months after beginning a residency, and a certifying exam, also computerized, taken 15 months after completion of a residency program. According to the Board's overview of the changes, dated June 2008, exam content will be based on the student's training profile, experience, and planned practice emphasis.

Levon N. Nazarian, MD, professor of radiology and program director of the diagnostic radiology residency program at Thomas Jefferson University in Philadelphia, doesn't foresee many changes to the curriculum for the first three years of residency, except perhaps to alter the manner of teaching toward the new style of testing as opposed to the traditional oral exam.

The real change, which will occur in the fourth year is two-fold, Nazarian says. The first is the on-call schedule. Fourth years are going to take on more call than they used to, which may also benefit patient care. "By changing the board structure you actually can make available your most experienced residents," Nazarian says.

The second, and conceivably more controversial, change is that fourth-year residents will be able to dedicate more time to subspecialty training in one or more areas. Nazarian says his program intends to offer this form of "mini-fellowship" to fourth-year residents, but he notes some potential pitfalls to the system. Allowing residents to choose one or more areas of focus could result in one subspecialty being overburdened with residents while another is left without any. Also, fellowships could risk becoming less in demand.

"We just cannot possibly accommodate the number of people that deserve interviews."

"The effect of these changes really remains to be seen," Nazarian says. "For example, what is the job market going to be like? Let's say the job market is really hot for graduates. They do that mini-fellowship, and then they take a job to be the neuro person since they did a year of neuro in their residency. But if the job market is tight, then graduates may still feel that in order to make themselves more attractive as employees, they're going to have to do fellowships."

To discourage students from choosing to forgo a fellowship, Valerie P. Jackson, MD, FACR, John A. Campbell professor and chairman of the Department of Radiology and Imaging Sciences at Indiana University School of Medicine in Indianapolis, says her program intends to elevate and differentiate the fellowships from the fourth year of residency. "They'd have maybe more experience working with surgeons or medicine clinicians or pathologists or whatever related to the area of their subspecialty," she says.

Many educators believe it was time for a change. Jackson says the requirements for residency training hadn't changed in more than 30 years. Radiology practice, however, has changed dramatically during that time, and broad general radiology isn't practiced as commonly.

"It turns out that when most radiologists go into practice, they don't practice every aspect of radiology," Jackson says. "They tend to focus on one, two, three, or maybe four areas and then do some more general stuff. They're not just trying to learn a little bit about everything and practice a little bit about everything."

Interest in the field has steadily climbed for the past five to six years, with Jefferson's program receiving record applicants. Nazarian says the program has close to 800 applicants for only seven spots available in the upcoming match.

"The number and quality of applicants is just unprecedented this year," he says. "We just cannot possibly accommodate the number of people that deserve interviews. It's amazing."

RT Programs

Earlier this year, the American Registry of Radiologic Technologists (ARRT) board of trustees voted to require that beginning Jan. 1, 2015, candidates applying for certification in radiography, nuclear medicine, radiation therapy, MRI, and sonography must have earned, at minimum, an associate's degree.

Cindy Daniels, MS, RT(R)(ARRT), the director of education requirements and registration for the ARRT, says that the rapidly-changing profession will benefit from technologists' having the core knowledge developed while earning an associates degree.

"We feel that it's important to patient care that technologists be able to demonstrate those good communication skills - writing, English, sociological understanding, and psychological insights - even though they may not directly impact the profession as far as the sciences and the math that we use day to day," she says. "The requirement is intended to prepare the graduates and people entering the profession for the next generation of where things in the profession are going."

Aimee Phillips, MS, RT (R)(M)(CV)(QM)(ARRT), staff development specialist at Marietta Memorial Hospital (MMH) in Marietta, Ohio, and a member of the MMH School of Radiologic Technology Advisory Board, believes that the requirement will encourage students to think beyond their short-term career goals.

"I feel that this will instill in future radiographers the importance of education," she says. "Individuals will see that by obtaining more education, they can move into areas such as management, PACS/IT, education, and even staff development."

While this requirement will not affect degree-awarding programs, there is concern among hospital-based certificate programs that their students would not be interested in earning an associate's degree.

Kevin Powers, EdS, RT(R)(M), director of education for the American Society of Radiologic Technologists (ASRT), assures that meeting the requirement shouldn't be an impossible burden for these programs.

"It's different for us, but it's not uncommon for other professions," he adds. "There are unique opportunities for linkages between academic intuitions and some of the hospital-based programs that would be of mutual benefit to both organizations."

Between 2005 and 2007, there were rumblings about a possible shortage of radiographers in the job market. Going into 2010, however, the concern is quite the opposite.

"We've flooded the market," says Leslie Winter, MS, RT(R), CEO of the Joint Review Committee on Education in Radiologic Technology (JRCERT). "Our programs are having problems placing students. Their job placement rates are not as good as they were back in '05."

Winter says the number of JRCERT-certified programs is at an all-time high of about 750 programs, which she attributes to the poor economy.

"People were looking for career changes or lost their jobs and were looking for a second career," she says. "They flooded to the community colleges, and we saw a huge influx of new programs."

The focus of RT programs has begun to change as well. Schools are putting more emphasis on digital imaging rather than cut-sheet film, and both radiography and radiation therapy programs are integrating courses dedicated to CT.

"CT, as well as MR, needs to be integrated to some degree in the entry-level preparation for radiation therapy technologists, because they're finding more and more of the hybrid equipment being installed in the radiation therapy arena," Powers says.

As technology continues to change, educators will update and alter the information they provide students. At the end of 2010, Powers says the ASRT will begin the process of revising the radiography curriculum, which is updated every five years to keep up with the industry.

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