The department offers a four-year program in Diagnostic Radiology.  All trainees must have one or more years of graduate training in another clinical specialty before beginning Radiology. We do not offer an integrated internship as part of our program; there are a number of good transitional programs in the area. The faculty/resident ratio in the department is 1:1, there are approximately 10 hours of teaching conferences per week, and althoughmany of our faculty are leading researchers, they are uniformly dedicated and enthusiastic teachers; these are just several attributes of our program that illustrate our continuing commitment to resident education. In spite of all the changes in rules, regulations, and adult learning theory, radiology training is still part apprenticeship,part self-learning, and part exposure to advanced science. We believe our program provides all of these in a friendly, positive environment where the residents are a valued and respected member of the healthcare team.

At the start of the first year of training, one day each of hospital and department orientation occurs, followed by an introductory overview course of 30 hours given by the faculty from early July to mid-August. This course is dedicated for the first year residents and presents radiological techniques and the basic principles of Diagnostic Radiology in each sub-specialty. It is meant to serve as an introduction to the specific services, and begin the process of making the first year residents comfortable with discussing cases in front of colleagues. An important part of this process is developing a logical approach to findings and differential diagnosis. The course includes the fundamentals of radiation physics, radiation protection, patient protection and patient preparation; indications and contraindications for radiologic procedures; the nature, use and hazards of contrast material; treatment of contrast reactions; and the performance of all the common radiographic procedures.

First year residents begin their training with approximately four-week rotations paired with a more senior resident on the major services. This has been a very successful approach for orienting junior residents. The residents receive instructions in the production of radiologic images, the performance of procedures and the techniques of film interpretation and reporting. The first year resident takes on increasing responsibility during these rotations. All films interpreted by first year residents are "pre-read" as time permits, and reviewed by a faculty radiologist before dictation of the report.  Increasing skill results in the resident being allowed to pre-read and dictate reports before faculty checkout of his or her cases. All interpretations and written reports of the residents are checked by faculty radiologists not just because of Medicare rules, but because it is good for patient care and the education of the individual resident. Feedback is given regarding the efficient use of our voice recognition system, appropriate use of language/jargon, and structure of the written report. Because reports not only affect patient care, but have billing and medicolegal implications, we strive for the first year residents to form good habits early on. We have developed goals and objectives for our clinical rotations that are based on ACGME Core Competencies. For an example of our Curriculum for Abdominal Radiology, click here.

The first-year resident begins weekend daytime call by assisting a senior resident during months 3 to 6, and then begins taking greater responsibility for cross-sectional studies in months 7 to 12, with the senior resident being on-site and reviewing all the first year resident interpretations. Solo night and weekend call begins after twelve months in accordance with ACGME guidelines. The residents play an important role in making decisions about cases during the day, so night call decision making feels very familiar to them, as does knowing when to involve faculty and/or fellows for back-up. The Department has a robust teleradiology system, allowing for easy consultation after hours should the resident or other clinical faculty deem it necessary. The Department also subscribes to STAT Dx (published by Amersys), which has become a valuable electronic source of information. Emergency radiology books and other on-call resources are maintained in our Body CT reading room (the home base of operations when the resident is on-call).

The resident is given ever-increasing responsibility in film interpretation, reporting and in the performance of radiologic procedures during the second through fourth year. As the resident transitions to the second year of radiology, they become more independent in consulting with clinicians, discharging patients after minor procedures such as gastrointestinal fluoroscopy, and pre-dictating cases before review.  With increasing competence, a balance is achieved between proper patient supervision to ensure adequate patient care and the development of the resident’s individual freedom and initiative.  All films and reports are “double read” and signed by both the resident and appropriate staff.

During the third year, the resident spends three months in Pediatric Radiology at Children’s National Medical Center (CNMC) and 4 weeks at the Armed Forces Institute of Pathology. Both are extremely valuable rotations. CNMC is consistently ranked as one of the top pediatric hospitals in the U.S. We have very close ties to CNMC, and the “Children’s” faculty primary academic appointments are through our department at GW. Our faculty contribute to the Interventional Radiology service at CNMC and play an active role in their Vascular Malformation Clinic. Dr. Raymond Sze, a NIH-funded investigator, is the Chairman of this outstanding subspecialized pediatric radiology department.

In the fourth year the residents spend 2 weeks in Nuclear Radiology at the National Naval Medical Center in Bethesda, Maryland. This allows them to meet the didactic requirements specifically needed to become eligible as an authorized user of isotopes for the Nuclear Regulatory Commission. Because we have a high volume of procedures in areas such as trauma, OB ultrasound, and cardiac nuclear medicine to name a few, we do not find it necessary to send the residents to other community affiliates. The rotations are re-assessed periodically, with close feedback from the residents, and these may be adjusted or new rotations added from time to time to improve training.

The Educational Environment

The GW Medical Center has very active Graduate Medical Education programs in almost every discipline. The radiology residents enjoy the respect and collegiality of many of their colleagues in surgery, medicine, emergency medicine, OB, and neurology to name just a few. Cardiology, GI, and hematology-oncology are 3 of the medical subspecialties at GW, where we have formed especially close bonds and excellent working relationships. Throughout the residency there is an intensive program of conferences, lectures and didactic courses. Most days there is a 7:30 am and 12 noon conference mixing didactic and case material. Each subspecialty has its own detailed written curriculum that is covered in conference. Each specialty has also designated 8-10 core lectures that repeat every one to 2 years.  Many of the lectures are electronically available for review on one of the computers in our radiology library. Conferences are often given by visiting lecturers as well as our own full-time faculty.  The Department has regular journal clubs (led by the Chief Resident and Dr. Brem), a research conference, and proven case conference to name a few. The latter has proven especially popular, and has evolved into the residents presenting cases to each other under the guidance of faculty members. There are bi-monthly Radiology-Pathology-Medicine and weekly Tumor Board conferences with cases discussed by members of each Department. The residents play a leadership role in presenting at these multi-disciplinary conferences. There are bi-weekly interdepartmental Pulmonary, Gastrointestinal, Neurological and Head and Neck conferences.  Residents and faculty may also attend Medical and Surgical Grand Rounds (workload permitting), and there are multiple daily interdepartmental film reviews. Monthly Quality Improvement and Mortality/Morbidity Conferences are mandatory and run by Dr. Brindle. Dr. Zeman leads non-interpretive, system-based discussions on a wide range of topics based on his understanding of the business of radiology and the many economics, regulatory and safety committees he has chaired. His weekly Tuesday morning Chair’s conference covers many abdominal, CT, nuclear medicine and cardiac imaging topics in addition to leaving time to discuss departmental  and resident issues, hot topics from our national meetings, etc.