RADIOLOGY RESIDENCY TRAINING PROGRAM

Introduction

• Residents will rotate through the three participating London hospitals (University Hospital, Victoria Hospital and St Joseph’s)

PGY1 – First Year Residents

• a clinical year designed to strengthen experience in medical, surgical and other specialties
• includes at least two months of Ultrasound/CT training in Abdominal Imaging and  also Neuroimaging
• on-call duties generally start in December
• consists of one month rotations in major medical and surgical disciplines that are relevant to a career in imaging
• nine mandatory and three elective rotations are organized
• resident evaluations are sent to the Program Director, and periodic reviews of the rotations are made to ensure that they remain of high quality
• no more than 2 of these months can be nonclinical.

PGY2 – Second Year Residents

• general exposure to the main areas of Radiology, including Chest, MSK, Emergency, ICU, Abdominal Imaging, Neuroimaging and Mammography
• first year of formal Radiology exposure.
• a general year with residents rotating through the three hospital sites.
• introduces residents to the core knowledge base required in radiology, and also the imaging modalities.
• rotations are divided into 1 month blocks, and are sited at the hospitals that have the best caseload for each area of imaging
• there is some exposure to interventional procedures
• the resident learns many technical skills of exam performance, the care and use of equipment, and is expected to demonstrate growing independence and skill
• designed to prepare the resident to take call: 
  

  - residents begin taking "buddy" call with senior residents in August, and    independent call begins in December.
  - rotations have a heavy emphasis on neuro and abdominal imaging
  - special "call prep" set of didactic lectures
  
  

PGY3/PGY4 – Third and Fourth Year Residents

• time spent in subspecialty rotations
• responsibilities within each rotation are dependent on the abilities of the resident, technical aspects of the rotation, and hospital policies

NOTE: responsibilities will increase over time to maximum possible familiarity with the subspecialty

• consist mostly of subspecialty rotations of three months duration
• Cross sectional imaging comprises six months of PGY3, and includes ultrasound, CT and MRI instruction
• residents rotate through St. Joseph's Hospital, and Victoria and University Campuses of the London Health Sciences Centre, optimizing the strengths of each institution
• Pediatrics and Neuroradiology rotations are nearly identical for all residents.
• there is some variability in clinical experience in nuclear medicine and angiography, as residents may be based at one of several institutions
• all residents have the option of attending the four week Armed Forces Institute of Pathology course held in Washington DC during these years of training.
  

PGY5 – Fifth Year Residents

• final year residents build on consultant skills throughout rotations in all areas of Radiology, prior to Royal College Exams and either Radiology practice or fellowship
• during this final year the resident will be comfortable and relatively independent; still using the teaching staff for individual consultations
• elective time is available in radiologic subspecialties, basic sciences in PGY4 and PGY5. 
• there is time available for research projects as well
• in the final year, residents have elective time, and are expected to spend a considerable amount of time in general radiology, integrating previous experiences, relearning old skills and developing more experience with routine and subspecialized imaging
• residents are given considerable flexibility to tailor the final year of training to their needs, it may be additional training in areas of weakness, or to obtain a more focused training in areas needed for future employment
• residents progress to greater responsibility and are expected to act as junior staff members, acting with enough responsibility to triage patient investigation and to consult with clinicians
• there is also some education responsibility for teaching of junior residents, medical students and technologists 
• consultative skills are honed in this year

SPECIALTY ROTATIONS

• these are usually taken as three month dedicated blocks

Angiography and Interventional - 3 Months

• this rotation is divided between University Campus and Victoria Campus
• the caseload and mix reflects the clinical services at each hospital. All transplants are performed at University Hospital. Most trauma and vascular surgery is performed at Victoria. St. Joseph's has a lithographer machine with its attendant need for urologist intervention.
  

Neuroradiology - 3 Months    

• this rotation is shared between University Hospital (2 months) and Victoria Hospital (1 month)
• the University Hospital portion reflects the clinical interest in stroke, intracranial aneurysms, vascular malformations, tumours and epilepsy.
• the rotation at Victoria includes CNS and H&N CT and MR for adults and pediatric patients
  

Paediatrics - 4 Months

• this rotation is distributed between PGY3 and 4, and gives exposure to the unique imaging needs of paediatric patients
• this rotation is taken at Childrens' Hospital of Western Ontario, a part of Victoria Hospital
  

Nuclear Medicine - 3 Months

• three months are taken in the Nuclear Medicine Departments at any of the three hospitals.
• an overview of the relationship of nuclear medicine imaging to radiology is given with commensurate practical experience
• a greater number of months can be taken to allow residents to qualify to write the American Board of Radiology (ABR requires 4 months Nucs between PGY2-5 to sit the American examination)

Cross Sectional (Body C.T., Ultrasound, Musculoskeletal M.R.) - 6 Months

• this is a six month rotation with three successive periods of 2 months at each teaching hospital where you will be able to take advantage of the strengths of CT and US at each facility
• body MRI is taught primarily at University Hospital.
• the range of examinations reflects the clinical services and interests of the hospitals
• for instance, regarding ultrasound caseload, University Hospital has a large number of transplant and infertility patients, Victoria Hospital runs the Genetic Defects Clinic and St. Joseph's Hospital has the largest obstetric load and the neonatal unit

Breast Imaging - 3 Months

• these rotations are distributed over the PGY years, mainly at St. Joseph's
• there is exposure to a large number of routine and special mammographic examinations, ultrasound and MR studies
• procedures such as preoperative localization of non-palpable lesions, stereotactic biopsy and ultrasound guided biopsies are included
• exposure to large volumes of screening mammograms are provided through the Ontario Breast Screening Program.

RESIDENT EVALUATION

• residents are evaluated for each rotation to assess their progress in each of the CanMEDS competencies. 
• there are also 3 objective examinations that residents take each year of residency from PGY2-5:

1) American College of Radiology Examination (PGY2-5)
This is a multiple choice examination, sat in February of each year. The results are returned to the Program Director and resident. Results are given in raw score form, and as a percentile according to the year of study. This serves as a useful guide to general progress, and identifies specific areas where extra work may be needed.

2)  Oral Examinations (PGY2-4)
The staff at the hospitals hold oral examinations at the end of each year for PGY2-4 residents.   PGY5 residents receive a large number of practice exams.

3) Objective Structured Clinical Exam (OSCE  for PGY2-5)
This examination will be held annually in February. Residents rotate from station to station to demonstrate clinical or interpretation skills, communication ability, interview skills, etc.

 

 

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