Teleradiology helps propel UC-San Diego’s top-tier radiology residency program

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 - Alexander Norbash, MD
Alexander Norbash, MD

No world-class radiology residency program ever attained its excellence without securing and sustaining department-wide buy-in on the criticality of teaching the next generation of radiologists. Clinical care and research don’t need to be de-emphasized in any way, but every faculty member in the department must be committed to teaching while sincerely appreciating the value of the residency program in ensuring the present and future health of the profession.

That, in paraphrase form, is the working philosophy of the radiology chair at UC-San Diego, home of one of the most forward-looking radiology residency programs in the country. “There has to be open communication, there has to be involvement of the faculty in policy and curricula, and each member must be giving an equal share of lectures,” says Alexander Norbash, MD, who joined UCSD two years ago, bringing with him many years of residency-program experience from Harvard, Stanford and Boston University.

It’s also a must to have a performance-appraisal process in place—one that facilitates evaluation of both faculty and residents, Norbash adds. “So there is a little bit of bureaucracy that is necessary to make a good residency program work, but mostly it is a matter of commitment,” he says. “It takes a team orientation among the faculty and a dedication to teaching across the entire department.”

Norbash shared his thoughts on building a successful radiology residency program, including insights into the value a strong teleradiology supplier can add to the endeavor, in a recent phone conversation with Medical Imaging Review.

Flourishing on the teaching front

While UCSD’s radiology residency program is formidable for its size alone—it averages 10 residents per year—its distinguishing features have more to do with programmatic creativity than head counts. For starters, each year it’s home to three residents who spend their entire first year entirely focused on research. This prolongs their residency by a full year, building momentum for the research tracks they’ll take on during each of their four subsequent years.

“What we have found is that those residents have a very high likelihood of going into academic practice,” Norbash says. “They are remarkably prolific. And they have a very high incidence of securing grant funding. The program was started by [UCSD professor emeritus] Dr. Robert Mattrey, and it is successful beyond our wildest dreams.”

The residency program was one of the first in the country to incorporate a primary certificate pathway for interventional radiology, training residents based on a new set of criteria established by the American Board of Radiology. “We believe this is going to help us secure the future of interventional radiology,” says Norbash, who is himself a neurointerventionalist. “It’s also strategically important to our profession because interventional radiologists are uniquely suited to understand the needs of the patient and to help create patient-centered initiatives.”

In addition, and perhaps most importantly, the leadership of the radiology residency program at UCSD has seen the future of radiology and it is communication. "Workloads have increased to the point where our residents are very busy, our faculty are very busy and everyone throughout the department has less time to think, strategize and discuss challenges and opportunities," Norbash explains. He says they’ve set their sights on a number of strategic “destinations” to get where they need to go with communications.

This list includes becoming more data-driven, more transparent and growing in intentional ways. Undergirding these and other initiatives is a concerted effort to attune all department members’ ears to radiology as experienced by patients, co-workers, referrers and, not least, one another. Without that last piece, Norbash says, “we would face increasing rates of burnout, job dissatisfaction and poor work-life balance.”

A tight teleradiology-residency connection

The push for better communications and related aims will entail a considerable investment of time, effort and energy, Norbash says. But the heavy lifting on the front end will yield a radiology department—and its already-outstanding residency program—well-positioned for many years of continuous quality improvement, to the benefit of all the stakeholders it serves.

Effort and energy are one thing. But where is the time going to come from, especially given the ever-expanding workloads the department is seeing? One key source, Norbash replies, is UCSD radiology’s relationship, now nearly 10 years old, with teleradiology provider vRad.

“vRad improves our operational efficiency and improves the quality and safety of the work we do during off hours, as an example,” he says. “Plus, by giving us flexibility, it directly addresses work-life balance and burnout issues. And it helps us avoid the need for an in-house 24/7 radiology service, which wouldn’t generate additional revenue but would incur a dramatic amount of increased costs.”

Meanwhile, having a responsive, highly subspecialized teleradiology service ever at the ready increases the depth of the training residents receive, Norbash says.

“These are high-quality reads, so the residents understand, from an operational as well as an interpretive perspective, the value of vRad,” he says. “In terms of their exposure to nonclinical curricula, they understand that the methodology vRad uses to do quality assurance—measuring turnaround times, using metrics to drive the business—is part of the business of radiology. So they learn, on multiple levels and from several aspects, from our coverage model with vRad.”

Customer-service standout

Although Norbash inherited the UCSD-vRad relationship, he arrived in San Diego familiar with the utility of teleradiology for overnight coverage. He’d also already seen how the service could support residents by, for example, giving expert overreads to their first reads. What was somewhat new to him was UCSD’s enthusiastic embrace of the service as a veritable extension of its own operation.

“I personally see vRad as an indispensable part of the fabric of our department. I see this as a partnership,” he says. “It provides a tremendous amount of reassurance to a chair, at the managerial level, to have a reliable reserve parachute in case you have departure of faculty or in case there is a disaster that leads to a short-staffed situation.”

It further helps, he adds, that vRad has proven a standout when it comes to providing attentive customer service and responding to evolving needs in the marketplace.

“When it became apparent that final reads were of interest to radiology departments, vRad was quick to respond to that desire by formulating an effective price point as well as an effective ability to provide that service,” Norbash says. “In addition, as radiology departments were becoming dependent on data to understand performance internally, vRad became a leader by supplying scorecards, showing how departments can improve their performance and increase their confidence.”

Forming tomorrow’s leaders today

Finally, Norbash appreciates that vRad demonstrates its commitment to the partnership by, for example, regularly traveling to meet face-to-face with UCSD radiology.

“They are very attuned to the need for cultivating a relationship with a customer and understanding the customer’s needs,” Norbash says. “I have found vRad to be very informative, very interested and very involved.”

He adds that he looks forward to continuing the relationship for many years to come. This thought brings him back to—or forward into—UCSD’s radiology residency program.

“As I look toward the next 10 or 15 years, I’m extremely excited to participate in teaching radiology residents,” he says. “I find it particularly exciting to help form the leaders who are going to forge and architect the future of patient care and medical research. It’s very rewarding to know that, each day, you’re playing some small part in creating tomorrow’s radiology.”

To learn more about how vRad supports radiology residency programs, click here.