Often in matters of comparison of health care between the U.S. and elsewhere I take a critical view of the American product. Not this time. I want to say straight out that after a visit to participate in the annual meeting of an organization called Management in Radiology, which is an association of European radiologists akin in purpose and purview to the Society of Chairman of Academic Radiology Departments (SCARD) in the US, I came away with the conviction that in our country we prepare our residents much better than they do in every country in Europe. Our training paradigms are evidently more extensive in scope, more uniform in content and more committed to the education of radiologists of the future than is the case in most European countries. We have incorporated into them standardized instruments and policies for review and surveillance that are mostly lacking on the other side of the North Atlantic.

This comparison is based upon two major distinctions between here and there. In the US, our capacity for organization and our zeal in providing structure in medical education is built on a long-standing tradition beginning with the Flexner Report for medical school education in the early 1900s progressing to the establishment of specialty boards and board examinations in the 1930s and afterward to the development and maturation of the Accreditation Committee for Graduate Medical Education in the 1970s and 1980s and with its mandate for specific regulations which are constantly in evolution.

In comparison, Europe is a collection of 50 plus countries, some very large, and others mere statelets. They have differing organizations and systems of healthcare of medicine, and differing perceptions of the balance between the profit motive and the need for universally available social services. Recent efforts at integration of care across national borders have followed in the wake of the expansion of the European Union but they are not in lockstep with it. Moreover, to a much greater extent than in the US the number of radiologists in relation to population varies widely from place to place, and especially from country to country. Thus, it should not be expected that there would be homogeneity in Radiology training programs across Europe.

Recent attempts at integration are well-meaning, but they are limited in scope and halting in implementation. Two important developments stand out; both of which have occurred in the last 5 years. In 2004, in order to assess the existing differences in radiology graduate medical education, a survey was conducted by the European Association of Radiology (EAR), an organization which has since 2005 been known as the European Society of Radiology (ESR). In any event, in 2004 the survey was addressed to the various national radiology societies to gain an overview of the nature of residency training in each. The results of the survey demonstrated the existence then and now, of a wide spectrum of permutations with respect to entry requirements, training schemes, curricular manifestations and resident evaluations. Responses were collected from 24 of those countries including most of the large nations and a range of smaller ones. Notable omissions included Finland, Turkey, Bulgaria, Serbia, Belarus, and the Ukraine.

Here are some specifics which I hope you find interesting. Overall, in relation to US programs and among European countries, I found disparities to be much greater than resemblances. For example, residencies in 12 countries mandate passing a national examination before beginning residency, and 6 countries require passing a local exam. Therefore, six countries have no such

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