- What are the principal objectives of the program?
The principal objectives of the training program at Jacobi Medical Center are to provide didactic teaching and a working exposure to a wide range of pathologic conditions. The resident who takes advantage of the program and who supplements that experience with reading will complete the four years of training confident regarding his/her ability in all areas of modern radiology. Our graduates are able to technically perform all standard radiologic procedures, identify the abnormality on the resultant study, formulate an appropriate differential diagnosis, discuss the case cogently and concisely with referring physicians, and are able to arrive at the best possible diagnosis utilizing both clinical and imaging parameters. Residents completing this program should be able to pass all sections of the written and oral examinations of the American Board of Radiology, be competitive for top-notch fellowships, and ultimately be sought after for prestigious positions in the academic or private practice of Radiology.
An additional objective is to make the resident aware of the importance of continuing medical education and personal medical development. This is accomplished by virtue of the emphasis on daily intradepartmental conferences, visiting professors, sending the residents to local and national conferences, and to the AFIP at departmental expense.
The importance of research is emphasized to the residents. They are required to prepare one paper suitable for submission for publication during the four year training program. Many residents have co-authored manuscripts in peer-reviewed journals with the faculty. When the resident assumes the major responsibility for a manuscript, that resident will be the principal author.
A further objective is to stress the importance of quality assurance issues. Issues discussed include appropriateness of care, complications of procedures, reports on missed diagnoses and adverse drug reactions. The needs of the referring physician and hospital are also addressed, including the necessity of responding to both in a timely, efficient, and clinically correct fashion.
The institution has acquired a state-of-the-art PACS system which is interfaced with our radiology and hospital information systems. The system is also interfaced with our voice-recognition dictation system, making reports immediately available on-line with relevant images. This has dramatically enhanced our department's ability to render timely radiologic services as well as prepare residents for the major technologic advances which are being implemented throughout the nation in radiologic facilities.
- Explain the provisions for graduated resident responsibility.
Before residents are allowed to independently render on-call preliminary interpretations in the Emergency Department setting, they receive one year of training covering virtually all subspecialty areas and pass a written and practical (image interpretation) examination which "certifies" the resident to function alone. This period of training is mandated by the Accreditation Council for Graduate Medical Education (ACGME). Increasing resident responsibility and autonomy is granted in all rotations as experience is gained under the supervision of the staff radiologists. As it becomes obvious that the resident is capable of functioning on a more independent basis, supervision is reduced appropriately but never removed entirely. At no time during the four years of training are residents allowed to perform invasive procedures without a supervising staff radiologist immediately at hand.
- Describe the organization of the teaching services.
As much as possible, the teaching services are organized by organ systems. There are divisions of chest radiology, abdominal radiology, musculoskeletal radiology, and neuroradiology. We also have divisions of mammography and emergency radiology because of a recent emphasis placed on these subspecialties. We also have an ultrasound division because of the highly specialized nature of this field and its extreme operator dependence. The hospital has acquired a new MRI facility, which is within the confines of the building, at which residents spend a dedicated period of time. This allows residents to become familiar with the technical aspects of the acquisition of MR images as well as concentrated instruction on the interpretation of MR imaging. In addition, of course, residents obtain experience interpreting MRI as they rotate through the various radiologic subspecialties. By reviewing studies of other radiologic modalities and evaluating these studies in comparison with information obtained from MR imaging, cross-modality correlation is obtained. There are also separate divisions of pediatric radiology and angiography/interventional radiology. While the nuclear medicine department is an independent department, the radiology administrator manages both departments. There is a long tradition of cooperation between our departments in providing nuclear medicine training for our residents. For each area of specialization, there is a dedicated individual responsible for the training of the residents as they rotate through the respective clinical sections.
- Explain attending coverage and resident supervision.
During normal working hours, there is full specialty coverage throughout the Department. During evening and weekend hours, there are on-call attending staff in interventional radiology, neuroradiology, pediatric radiology, and general diagnostic radiology. The Department of Nuclear Medicine also has a staff physician available for consultation. Members of the attending staff are also present at scheduled times in the department on Saturdays, Sundays, Holidays, and weekday evenings to review cases interpreted by the residents and provide other consultations that may be requested. Furthermore, there are separate rotations of attending staff with expertise in Abdominal CT and Neuroradiology studies including MRI, to review CT's done outside of regular business hours. Throughout the entire department, all studies in which a resident is involved are double read by staff radiologists.
- Is there supervised experience in interventional procedures?
The experience in interventional radiology is very carefully supervised. In no instance is a resident allowed to perform an invasive procedure of any significance without an attending staff member directly assisting the resident. All invasive procedures involving resident participation are documented as required by the American Board of Radiology.
- Is there a defined Cardiac Radiology rotation?
Residents do not rotate through a defined cardiac radiology rotation. Residents gain their experience in cardiac radiology in their rotations in pediatric radiology and chest radiology. Additionally, there is one conference per week dedicated solely to cardiac radiology.
The hospital has acquired a cardiac catheterization lab which we anticipate will increase the number of referrals for cardiac evaluations. Our MRI and CT scanners are being equipped with cardiac software, and several of our faculty have expertise in this area.
- How is experience in CT, Ultrasound, and MRI obtained?
The residents gain experience in CT and MRI on their chest, abdomen, musculoskeletal and neuroradiology rotations. They are encouraged to review any ultrasound studies performed on their patients and correlate them with the CT and MRI findings. As noted above, there are separate rotations in ultrasound because of its unique nature and operator dependency. Residents are also taught the necessity of developing standard protocols to efficiently utilize expensive equipment such as CT and MRI. They are also taught to realize when it is necessary to deviate from these protocols in order to better define a particular problem or finding. When the residents rotate through ultrasound there is emphasis on "hands-on" scanning by the resident so that he/she may develop considerable skill in performing diagnostic ultrasound procedures. Proficiences obtained include evaluating for ectopic pregnancy, peritoneal fluid or blood, etc
- Explain the OB/GYN Ultrasound experience.
This hospital has a very busy obstetric/gynecologic service and, as a result, obstetric ultrasound experience is gained during the residents' rotation in sonography. The residents gain experience with fetal echocardiography in the evaluation of congenital anomalies, as well as other complicated obstetrical problems.
- Do residents receive six months of rotation in Nuclear Radiology?
As noted elsewhere, nuclear medicine is a separate department; however, working relations between the departments are excellent and the two chairmen meet regularly. The radiology department administrator also serves as the administrator for the department of nuclear medicine. Residents rotate through nuclear medicine for five months, but also obtain the equivalent of an additional month of training by participating in nuclear medicine on-call over the four-year training period and attending conferences, lectures and nuclear medicine grand rounds. The residents spend at least six hours per month in these activities over the four years of the residency, which provides at a minimum the equivalent of an additional one-month clinical rotation.
The American Board of Radiology has recently approved (in accordance with the new requirements of the NRC) a reduction in the number of hours of training in nuclear medicine from 1100 to 700 hours for candidates taking the oral exam in June 2005 and in subsequent years. Since that time, residents have been required to complete 4 months of training in nuclear medicine (rather than 6). Our curriculum has reflected those changes since July 2004.
- How is instruction in Radiology/Pathology correlation obtained?
There is a conference every other week devoted to radiologic pathologic correlation. At this conference, actual cases from the hospital are worked up and presented by the resident and the radiologic findings are then correlated with the gross and histologic pathology, which is presented by pathologist. The resident assigned to organize this conference will then make a short presentation describing the clinical, radiologic, and pathologic findings of the entity presented. Three cases are usually presented at each conference. All residents also attend the four week AFIP radiology/pathology correlation course. Tuition for the course and support for living expenses are funded by the department's radiologic education fund.
There is also a weekly conference of pulmonary medicine and pathology at which time there is a presentation of the clinical findings of current patients as well as radiologic findings and the subsequent pathologic findings. Residents also participate in the mortality and morbidity conference which is conducted at the morgue and radiologic findings of patients who have had autopsies are presented.
There is also a hospital-wide tumor board conference.
- Do residents receive instruction in Radiologic Physics?
Residents are given instruction in radiation physics by our full-time radiation physicist who provides a series of approximately 30 didactic lectures covering radiologic physics and radiation protection. A course on radiobiology is given by Dr. Eric Hall from the Columbia University College of Physicians and Surgeons. All residents attend this course, which is organized by the Department of Radiology at Montefiore Medical Center.
- Do residents keep a log book that documents procedural activity?
Residents are required to keep a log documenting their participation in all interventional procedures performed throughout the department. The program director or his/her designate reviews this log during semi-annual counseling sessions. This covers neuroradiology, angio/interventional and CT or ultrasound guided aspirations/biopsies/drainages. To comply with these requirements, at the end of each rotation the resident checks the number of procedures that were performed under supervision and the record is available for the American Board of Radiology and other professional oversight groups.
- Does any instruction occur outside of the hospital (eg private office)?
Residents are not instructed in private offices outside of the hospital. Jacobi medical center is the major teaching facility for the program in diagnostic radiology. It is a full-service hospital with subspecialty organization within the department. The Emergency Department is a level I trauma center and is staffed by physicians trained in emergency medicine. In addition to a burn unit the hospital is equipped with a hyperbaric chamber. A state-of-the-art high field MRI is onsite were residents gain"hands-on" experience in the modality. Although we have established an independent program, we still maintain an active joint teaching relationship with members of the Montefiore attending staff, who participate with our attendings in giving the daily conferences.
- How do the affiliated institutions contribute to the training program?
The training program is conducted at Jacobi Medical Center (JMC), which is part of the North Bronx Healthcare Network. North Central Bronx Hospital (NCB), which is the other hospital of the network and is located approximately two miles from Jacobi Medical Center, provides additional case material for teaching our residents since that hospital is linked to Jacobi Medical center by our: (1) PACS System, (2) RIS (Radiology Information System) and (3) HIS (Hospital Information System). Our attending radiologists frequently rotate to NCB. Our residents provide consultations on evenings and weekends to NCB providers. Furthermore, stereotactic breast biopsy equipment is installed at NCB and our residents accompany the attending radiologist performing these special mammographic procedures. The patients are from both NCB and JMC, and the residents gain expertise by working with the attending radiologist doing these stereotactic breast biopsies and other invasive mammographic procedures. The administrative and executive staff, as well as the attending physician staff for both hospitals, is one and the same. All CT studies (head and body), pediatric studies, as well as off-hour ER studies from NCB are interpreted at JMC.
- Do residents rotate at the affiliated institutions?
Outside of the experience gained by our residents when they accompany one of our attending staff to North Central Bronx Hospital, which is part of our network, residents do not rotate to affiliated institutions.
- What else can you tell me about the subspecialty rotations?
It is a policy of the program not to make assignments to any given subspecialty area for more than six months, either during the fourth year of the program or at any other time. When assigned to subspecialty rotations, residents are required to participate in our multiple daily conferences so they may continue to develop expertise in all areas of radiology in addition to their subspecialty training.
- Do on-call hours meet the ACGME requirements?
Night, weekend and holiday coverage is provided by residents on a rotating basis. Most overnight coverage is handled by a "night float" system, during which a resident is assigned to cover the evenings in the ER and is off during the daytime. Weekend and holiday coverage is also provided by residents at the second, third and fourth year levels. As noted above, first year residents are never assigned without senior resident for backup until they are "certified". The call schedule falls well within the ACGME guidelines as well as the very rigid guidelines set forth in the regulations of the New York State hospital code.
- Does the program provide training in BLS/ACLS?
Jacobi Medical Center provides training in both basic and advanced life-support. The course is provided without charge to the department and the residents. All residents are required to become BLS certified.
- How are residents evaluated?
Resident evaluations are conducted at regular intervals. After each rotation, the responsible radiology faculty member completes a standard evaluation form and results are then correlated by the program director. The staff, in a group evaluation, discusses the performance of each of the residents biannually in a formal session. The information from these sessions is added to residents record and general consensus is developed on each resident's progress. Each resident is then individually counseled by the program director and informed of his or her progress. The comments form is signed by both the resident and counselor and these evaluations are maintained on file. Counseling sessions between the program director and resident take place biannually for second third and fourth year residents and three times annually for first-year residents.
- Are faculty members periodically evaluated by the residents?
Faculty teaching and the residency program are evaluated annually by the residents on an anonymous basis. It is emphasized to the residents that they should provide an objective evaluation of the teaching capabilities of the staff and that personality should play no role in completing the evaluation forms. These are then used to create a confidential teaching profile for each staff member in the department. Each staff member receives a written analysis of his/her performance, including areas in which they should improve, and these ratings are discussed with them in person by the chairman.
- Describe the mechanism for periodic internal review of the residency program.
The Albert Einstein college of medicine which is the sponsoring institution, has an active committee on graduate medical education which periodically reviews all training programs.
- Conferences/Grand Rounds
- Who are the residents?
In the first full review of the current version of residency program of the Albert Einstein College of Medicine at Jacobi Medical Center was conducted in 2002. The ACGME fully approved the program without citations. Approval was also granted to expand the program from 12 residents to 16 residents. As of July 1, 2005, we reached our full complement of 16 residents. Four residents are selected through ERAS each year, and we have fully matched every year. Our residents come from a wide range of medical colleges from different geographical areas such as UCSD, New York Medical College, Baylor (Texas), University of Florida, Boston University, Indiana University & Albert Einstein College of Medicine in New York. There is a wide variety of neighborhoods that our residents can select to live in during their training. We currently have residents living in Manhattan, Riverdale, Westchester, Queens, northern New Jersey and Long Island as well as in the area near the hospital.
- What fellowships have recent graduates obtained?
Our residents have been successful in getting fellowships at top institutions nationwide. Following the split from the Montefiore program, our program graduated its first class of 3 residents in 2003. Here is a list of what our residents have done after graduation:
Body imaging--Beth Israel Medical Center, New York
Body imaging--Geisinger Health System, Allentown, Pennsylvania
Thoracic imaging--Montefiore Medical Center, Bronx, New York
Body imaging--New York University
Vascular and interventional radiology, New York University
Body imaging--Mount Sinai School of Medicine, New York
Body imaging--Memorial Sloan Kettering Cancer Center, New York
Body imaging--Memorial Sloan Kettering Cancer Center, New York
Emergency radiology--Massachusetts General Hospital/Harvard Medical School, Boston
Neuroradiology--University of Miami
Private practice--Fairbanks, Alaska
Neuroradiology--University of California, Los Angeles
Neuroradiology--New York Presbyterian Hospital/Weill Cornell Campus
Neuroradiology--University of California, Davis
Private practice--locum tenens firm
Body imaging--North Shore University Hospital, Manhasset, New York
Neuroradiology--Montefiore Medical Center, Bronx, New York
Neuroradiology--Los Angeles County Medical Center/University of Southern California
Body imaging--New York Presbyterian Hospital/Columbia Medical Center Campus
Chest radiology--New York Presbyterian Hospital/Columbia Medical Center Campus
Women's imaging--Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
Neuroradiology--New York University
Women's imaging--Montefiore Medical Center, Bronx, New York
Body Imaging--Montefiore Medical Center, Bronx, New York
Neuroradiology--Brigham & Women's Hospital/Harvard Medical School, Boston
Body imaging--North Shore University Hospital, Manhasset, New York
Vascular & interventional radiology--New York University
Nuclear medicine--New York Presbyterian Hospital/Columbia Medical Center Campus
Body Imaging--North Shore University Hospital, Manhasset, NY
Neuroradiology--University of Southern California
Neuroradiology--Mt. Sinai School of Medicine
Neuroradiology--New York Presbyterian Hospital/Columbia Medical Center Campus
Body Imaging--Montefiore Medical Center, Bronx, NY
Neuroradiology--Brigham & Women's Hospital/Harvard Medical School, Boston
Body Imaging--Johns Hopkins, Baltimore, MD
Musculoskeletal Imaging--Hospital for Special Surgery, NY