Clinical rotations
Subspecialty rotations are organized to provide the resident with graded and increasingly sophisticated experiences as the residency program progresses.
First Year Curriculum
During the first eight months of the first year of residency, trainees have core rotations in which they are exposed to the basic plain film modalities (chest radiology, gastrointestinal radiology, genitourinary radiology, musculoskeletal imaging, and pediatric radiology) as well as nuclear radiology. At the conclusion of these initial rotations, the residents are expected to have learned the imaging appearance of normal anatomy and basic pathology. Additionally, trainees are taught to perform a number of basic procedures, including arthrograms, barium studies, cystograms, and retrograde urethrograms.
Following these core rotations, residents are assigned to the first of two, week long, day-evening emergency department (ER) rotations (daily hours: 1:30 p.m. - 10:00 p.m.). On the ER rotation, residents have the opportunity to apply their newly acquired knowledge to acute care imaging under close faculty supervision (faculty members are available in the hospital at all times to review emergent radiographs).
First year residents also receive introductory training in body CT, neuroradiology (where they are primarily assigned to interpret neuro-CT examinations and to perform myelography), and ultrasonography (where they are expected to learn basic imaging anatomy and some basic pathology). They are assigned to one rotation at the Veterans Administration Hospital (where they concentrate on plain film interpretation and basic GI and GU procedures). Some first year residents will have their first rotations on vascular interventional radiology. In addition, first year residents are expected to learn a number of other skills, including acquiring facility with the hospital information and radiology PACS systems, dictating radiology reports, communicating unexpected results to referring physicians, and presentation skills including use of radiology images in teaching conferences.
Second Year Curriculum
During the first eight months of the second year, resident training is expanded to include more intense exposure to the cross-sectional imaging modalities and to interventional procedures. Residents return to body CT, neuroradiology and ultrasound for second rotations. Their responsibility on these services increases. For example, on the body CT service they are expected to review the emergent cases from the night before and daytime emergent cases. Second year residents also spend dedicated time learning to interpret Chest CT scans, cardiac imaging studies (on a cardiac CT/MR rotation) and neuro-MRI studies (on a dedicated neuro-MRI rotation). They are assigned to a second pediatric radiology rotation, during which time they are exposed to cross-sectional imaging studies in children. Additionally, second year residents receive their initial, or additional, exposure to procedures during rotations in Vascular/interventional radiology and cross-sectional interventional radiology. Second year residents also rotate onto the breast imaging and body MRI services for the first time, and return to gastrointestinal radiology, nuclear radiology, and the VA Hospital for additional experience.
Many of the early second year rotations are considered essential prior to resident senior, or "Superchief", call where residents render preliminary interpretations for all cross-sectional imaging studies performed during weekends, holidays, and nights. This on call responsibility does not commence until March of second year and is described in greater detail elsewhere.
Second year residents will cover the ER at overnight, from July through June, in one week blocks, from 10 pm – 8 am, on the ER “Nightfloat” rotation. Responsibilities are similar to daytime ER coverage, with the addition of nuclear medicine studies. However, residents on Nightfloat are much more independent. Although more senior residents, and ER Radiology faculty members, are in the hospital, the Nightfloat resident is interpreting different studies (plain films, fluoroscopy, and nuclear medicine) and will not have their cases staffed by faculty until the morning. This graded responsibility to independent work is considered a critical component of radiology training.
Integration of second year radiology trainees into the hospital health care system also continues. Second year residents assume greater responsibility presenting at intra- and inter-departmental conferences. Their dictation and communication skills should be improving. In all, the residency-training program at the University of Michigan is structured so that by completion of the second year, residents have been exposed to all major subspecialty areas.
Third Year Curriculum
During their third year, residents are expected to greatly augment the basic training they received during the first two years. Residents return to many of the plain film rotations (chest radiology, musculoskeletal radiology, and pediatric radiology) and also receive advanced training in the cross-sectional areas (CT, neuroradiology, and ultrasonography). Residents will return to nuclear radiology, pediatric radiology, and the Veterans Administration Hospital for a third time and spend three to four more weeks on Vascular/interventional radiology service. Third year residents receive one month of elective time, with rotations in body MRI and clinical research most frequently chosen.
Third year residents also, with rare exceptions, attend the Armed Forces Institute of Pathology (AFIP) radiology-pathology correlation course. Those few residents who choose not to attend the AFIP course receive incremental radiology pathology correlation training at the University of Michigan by attending additional interdepartmental conferences, and are also granted additional money for their resident book fund to help offset the loss of the AFIP didactic experience.
Fourth Year Curriculum
The fourth year is constructed around a flexible schedule. Fourth year residents are given the freedom to tailor their rotation experience to their individual preferences. There are now only a few required fourth year rotations: a third experience on the breast imaging service, a second rotation in genitourinary radiology, the balance of the nuclear radiology requirement (so that the total time in nuclear radiology equals the requisite 16 weeks), and final rotations in chest radiology, neuroradiology, pediatric radiology, and at the VA. Fourth year residents receive up to 4-5 months of elective time in the fourth year (with rotations in MRI and clinical research again most frequently chosen).
Fourth year residents have an extensive oral board review curriculum. They work directly with faculty, in hot seat style conferences for only their class, from 7:00 - 8:00 a.m. and 5:00 - 6:00 p.m., four days per week during March, April and May. Noon conference during these months is also focused on fourth year oral board preparation, though other residents also attend. Fourth year residents may attend a one week board review course outside the University of Michigan, or they may chose a week of independent study without clinical duties.
Duration of Rotations
In general, in the first year, residents rotate simultaneously in four-week blocks, an exception being the ER rotation which is in one week blocks. In the second, third, and fourth years, residents generally spend three or four consecutive weeks on a rotation. Occasionally, a resident may be assigned to a service for only one or two weeks. This is done to cover for another resident who is on vacation or because the resident has specifically requested a shorter rotation as part of his or her elective time.
Faculty Supervision
Virtually all rotations are organized to provide the resident with increasing responsibility, as he or she becomes more senior. These responsibilities are explicitly stated in the written goals and objectives for each rotation.
Although faculty supervision is mandatory throughout the residency, emphasis is increasingly placed on giving the resident the opportunity to make independent decisions, which are then reviewed by a faculty member. Residents are given graded responsibility in image analysis, reporting of results, and the performance of procedures. All resident-dictated reports are read and signed by residents, then reviewed and countersigned by faculty members.
