Transitioning to a new residency curriculum.

n important transition is under way in US diagnosticradiology residency training. Every program in thecountry is now composed of groups of upper-levelresidents following the traditional curriculum and lower-level residents following the new model. This transition hasbeen the topic of livelyand constructive conversation, partic-ularly at the annual meetings of the Association of UniversityRadiologists (1).In 2007, the Association of Program Directors in Radi-ology created the Residency Restructuring Committee tocarefully review the changes and anticipate their impact ontraining programs. Its roster includes directors of both largeand small programs, as well as members representing theAmerican Board of Radiology and the Diagnostic RadiologyResidency Review Committee. The committee’s assessmentof the challenges and opportunities of the new curriculumwerepublishedintheJuly2010issueoftheJournaloftheAmer-ican College of Radiology (2).Ifwelikenthe elements ofthenewcurriculumto pieces ofa puzzle, ﬁtting them together poses different challenges todifferent programs. In every case, however, residents havejust 36 months to prepare for the new core exam. One keyto negotiating this transition successfully is to assemble thepieces in a way takes account of each program’s speciﬁccircumstances. A ‘‘one-size-ﬁts-all’’ approach simply willnot work. Yet learning from the experiences of otherprograms can prove illuminating, and it is in this spirit thatwe offer some words of advice from Indiana University (3).SELF-EXAMINATIONSelf-examinationiscrucial.Toadaptsuccessfully,wemustﬁrstknow our own program. What are its strengths? What are itsweaknesses? This applies not only to residents’ experiencesbutalsotothecompositionandinterestsofthefaculty.Wheredo residents perform particularly well? Where do theystruggle?Inpart,wecanlookatperformanceontheAmericanCollege of Radiology in-training exams and the AmericanBoard of Radiology exams, but test scores alone do not fullycapture what residents need to learn. What departmentalsections have particularly robust and engaged facultymembers? And what are the net effects of other educationalactivities, such as fellowship programs? In what areas mightfellowstendtohaveapositiveor negativeimpactonresidents’experiences?The key to the self-examination is honesty. We need tobe honest with ourselves, and we need to be sure thatwe listen widely, encouraging residents present and past toshare their frank impressions. We also need to talk tochairs, section heads, and educationally committed facultymembers. Every section of the department needs to berepresented, to ensure a comprehensive overview. This takestime and effort, and it is important for departments to makethis investment to ensure a successful transition to the newcurriculum.Itisimportanttorememberthatself-examinationisnotthephase to specify speciﬁc numbers of rotations in differentsections or how such pieces will ﬁt together in the biggerpicture. The goal of this step is to arrive at a qualitativeassessment of how effectively each section educates residents.Difﬁcult decisions may lie ahead, and these choices can besuccessful only if they are grounded in a thorough process ofself-examination.ANALYZING THE OLD CURRICULUMThe building blocks of the new curriculum deserve carefulscrutiny. What can each rotation contribute to the residents’education, in terms of both preparing for the new coreexamination and helping them become good radiologists? Ifrotations are not pulling their weight in this respect, theymay need to play a diminished role.Historical precedent is less important than a vision for thefuture. If a particular rotation has marginal or no educationalvalue, then serious consideration should be given to its elim-ination from the core curriculum so that room can be madefor rotations that better prepare residents for the qualifyingexamination. Where possible, program directors can sharefrank feedback with underperforming sections and helpthem improve.Sections that are performing well or whose performancecan be raised need to be positioned appropriately in thecurriculum to help residents prepare for the core exam.