Changing Radiology Landscape Warrants New Residency Curriculum
Radiology has come a long way in terms of education in business practices and health-care policy, with residency-training requirements in competencies related to these subjects in place for more than a decade. Further commitment to and innovation within these curricula are warranted, however. That is the conclusion of a study1 led by Jonathan Medverd, MD, of the University of Washington. “Physicians come out of fellowship training knowing how to diagnose and treat pneumonia—as simple an example as that is—but when it comes to practice management, they have a much weaker foundation,” Medverd says. “From the study, it is clear that the importance of these topics is definitely well perceived. Development, though, is not where it should be.” The study entailed a survey of trainees and faculty members of radiology residency programs in the United States. These individuals were queried using three anonymous instruments, including separate emails sent to members of the ACR® Resident and Fellow Section (RFS) and the Association of Program Directors in Radiology (APDR) and a paper questionnaire distributed to RFS delegates during the group’s 2010 annual meeting and chapter leadership conference. Of the responses from which the conclusions were derived, 439 were submitted by RFS members; 65, by APDR members; and 56, by RFS meeting delegates. Wanted: Soft Skills More than 86% of APDR members and more than 96% of RFS members expressed favorable sentiments concerning radiology business curricula and deemed improved business-practice and health-care–policy curricula critical to the education of future radiologists. “It’s especially important when you look at how the health-care landscape is changing, seemingly by the day,” Medverd says. “If radiologists cannot and do not keep up, they will be left behind, and keeping up is just as much a function of business skill as it is of clinical skill.” The ideal curriculum for radiologists in training, Medverd says, incorporates several topics that are, the survey indicates, already widely addressed. Ethics—in the medical, medicolegal, quality, and business areas—fall into this category; so do radiology informatics, contracts and negotiation, medical billing and reimbursement, and evidence-based radiology. Nonetheless, according to Medverd, the survey shows that there remain some glaring gaps in the soft-skills area. “In the best-case scenario, a radiology business curriculum would include coverage of leadership and communication skills, which are vital to positioning practices for growth and fostering mutually beneficial, noncontentious relationships with hospitals, payors, and the like,” he notes. Curricula that delve into the intricacies of health-care policy are equally essential, he adds, as they will affect the manner in which decisions concerning patient care and the use of imaging are formulated. Practice governance, organizational models, and strategic-planning basics too, should fall at the top of the optimal radiology curriculum list; Medverd says, “They are not something that can be picked up by radiologists as they go along, but are needed if things are to run as they should”, with the entire practice on the same page in terms of roles, goals, objectives, and plans. From Medverd’s perspective, hard skills also merit a prominent place on the roster. These pertain to accounting principles, performance metrics, and personal finance. “Many residents have their heads so wrapped around their core medical studies that a financial statement (or a way to measure performance) is a foreign concept,” Medverd says. Changing Schedules and Delivery Medverd reports that the survey results also point to a need to alter the schedule within which at least a portion of this curriculum is covered. Ideally, he notes, coverage of foundation topics and skills common to practice management within all specialties should commence during medical school, rather than at the residency stage. Radiology residents, along with their colleagues in other specialties, frequently claim that “an inadequate amount of instructional time is devoted to the practice of medicine,” Medverd notes. Incorporating practice management into the medical-school curriculum, he believes, would free a sufficiently large block of time to address specialty-specific and advanced topics once physicians have entered residency. In turn, they could acquire the business knowledge that they need without compromising other facets of their education, he says. The mechanics of delivering radiology business education warrant refinement as well, Medverd adds. Survey respondents cited significant exposure to didactic lecture delivery of curricular content and less frequent experience with such alternative educational methods as journal clubs, small-group activities, panel discussions, and use of online materials. While the survey did not objectively examine the effectiveness of these curriculum-delivery measures, subjective comments by respondents indicate that improvements in current methods are needed, as is comparative measurement of standard and innovative curriculum-delivery procedures. Moreover, Medverd proposes, in cases where there is an absence or shortage of faculty members with sufficient expertise to teach the proposed curricula, a dedicated panel of specialized educators might be engaged to offer focused instruction on radiology business-practice and health-care topics. This approach, he says, could conceivably be modeled “after the role the previous Armed Forces Institute of Pathology (now known as the American Institute for Radiologic Pathology) occupies in radiopathologic correlation,” Medverd explains. “The ACR is definitely making inroads here with the Radiology Leadership Institute™, given that the society sees it as focusing on radiology business practices at multiple stages of radiologists’ careers,” he continues. In an ideal scenario, he says, national radiological societies that encourage residents to participate in their meetings would go one step further in supporting the business education of these constituents. “I see the societies holding seminars on health-care policy and radiological business principles—not just once a year, but several times, to build attendance and bring home the need for (and value of) this type of education,” Medverd states. “Other initiatives—such as experiential projects and other learning formats offered at residents’ home institutions—could supplement the seminars. Nothing is written in stone at the moment, but it’s all worth a hard look.” Julie Ritzer Ross is a contributing writer for Medical Imaging Review.