The Intern Year Before Radiology Residency: Valuable or Useless?
Academic radiology programs are discussing new (and possibly improved) ways for radiologists-to-be to gain clinical experience during their training years.
Do you remember your internship year before entering radiology residency? Perhaps you did a rotating internship, a surgical internship or, like me, you spent a year as an internal medicine resident. How much decision-making and other patient care management responsibilities did you shoulder? Or did your year consist mostly of so-called scutwork? How did the internship experience inform your work as a radiologist? If you had the magical ability to do so, what (if anything) would you change about that year? Radiology educators are pondering these very questions, some going so far as to consider scrapping the year entirely. Others think that novel meaningful clinical experiences can be created in other ways.
Host C. Matthew Hawkins, MD, asks his guests, Radiology Firing Line co-conspirator Saurabh (Harry) Jha, MBBS, and Tirath Y. Patel, MD, interventional radiology fellow at Baylor, about one of the hottest topics in radiology education: the value (or lack thereof) of the clinical internship year.
Look at the antique illustration above. You see a group of bearded, morose white male William Shakespeare look-alikes lacking protective gear (but sporting fashionable Renaissance ruffs) surrounding a cadaver with exposed intestines. I see one other key difference from modern health care, especially radiology. These men are not isolated from each other in cubicles, each with his own pile of cadavers and a sandglass to ensure a uniform number of minutes of autopsy turn-around time per cadaver. They don't appear to be pressured to hurry up and treat the body of this once-alive person as a bit of piecework on a factory conveyor belt.
At a time of increasing commoditization and productivity pressures throughout all of medicine, ICU team rounds in my radiology department have dwindled from daily visits by several teams 10 years ago to one or two teams a few times a week three or four years ago. Fast forward to today and these visits have completely evaporated. The exchanges would help us radiologists and our non-radiology counterparts understand how the other thinks about medical care, especially about imaging utilization and interpretation. We bonded over our mutual interest in doing our best for our shared patients.
When a rare team shows up now (less than once a month), the conversations seem more superficial and coolly professional. In the past, not only did I get to learn more about the hospitalized patients on daily rounds, but I formed invaluable relationships with colleagues. There are fewer opportunities to connect now in a fast-paced, volume-driven work environment. This is so antithetical to the patient-centered care paradigm that we are being strongly encouraged to espouse. If for no other reason, getting back to the essence of doctoring should be enough to make us scrutinize everything we do, including the internship year, and to be willing to make challenging but righteous changes.
In the podcast, the participants discuss eliminating the internship year, not because exposure to clinical experiences is superfluous for radiology trainees. Instead, they provide an appealing, compelling, and utterly rational reason for changing the status quo. Weaving a clinical thread (i.e. clinical experiences) throughout radiology residency (among more traditional threads, such as imaging interpretation and image-based procedures) could serve as an antidote to commoditization and result in radiologists (especially residents) becoming more integrated into clinical service lines. If residents train within such a restructured curriculum, once they graduate, they may more readily and naturally practice radiology in a way that aligns with the recent push to make our care more patient and family centered.
I recently retired after a 40 year career as a diagnostic radiologist in a busy hospital practice. I did a year of internal medicine prior to radiology. There is no doubt that I was better doctor and a far better radiologist because of that training.
All of us miss the personal interaction with clinicians that characterized the practice of radiology for many of my years in practice. Given the current nature of our practice, I would never choose radiology as my specialty again. Dark cubicles isolate us from the reality of the patient narrative. If we abandon the internship year we are planning our own demise into anonymity and obscurity. I am sorry for the British Rad from Penn, whose experience as an intern sounded woeful. My experience as an intern was wonderful with abundant patient responsibility.