(1)
Department of Radiology, UMDNJ-New Jersey Medical School, Newark, NJ, USA
Abstract
Since 1995, a salient development in Radiology has been the emergence and growth of subspecialization as a defining organizational principle for the distribution of work and expertise. At that time, 18 years ago, more than 80 % of recent graduating residents opted to continue their radiologic education in a fellowship program. Today in the last survey we undertook of the 300 senior residents taking our annual board review course, 94 % of them will spend a year (for some even two) gaining knowledge and skill in one of the well-defined distinctive concentration areas of diagnostic imaging. About one half of them will be enrolled in an ACGME-sponsored program-all of those in IR, Neuro and Pediatrics—and a few in Abdominal radiology and MSK-while the rest will be in an unregulated non-ACGME fellowship including most abdominal and MSK programs and all MR and Breast subspecialty trainings, too.
Since 1995, a salient development in Radiology has been the emergence and growth of subspecialization as a defining organizational principle for the distribution of work and expertise. At that time, 18 years ago, more than 80 % of recent graduating residents opted to continue their radiologic education in a fellowship program. Today in the last survey we undertook of the 300 senior residents taking our annual board review course, 94 % of them will spend a year (for some even two) gaining knowledge and skill in one of the well-defined distinctive concentration areas of diagnostic imaging. About one half of them will be enrolled in an ACGME-sponsored program-all of those in IR, Neuro and Pediatrics—and a few in Abdominal radiology and MSK-while the rest will be in an unregulated non-ACGME fellowship including most abdominal and MSK programs and all MR and Breast subspecialty trainings, too.
The reorganization of the ABR board examination was a response to the imperative of subspecialty experience and competence which by 2000 had become essential for Radiology to distinguish itself, by dint of standards of education and superior knowledge, vis-à-vis other specialties who were vying for a piece of the imaging pie. Some of those impetuses had already been successful by them, and other such victories have been achieved by non-radiologists since then. But we have won even many more turf wars than we have lost because we have established to some degree that each subspecialty encompasses a fairly well defined corpus of knowledge that others could not possess and only we could attain by completing a fellowship.
And so to further legitimate subspecialty training, the reorientation of the board exam encourages the achievement of special competence in a formal way through the passage of its certifying exam, which is designed to be flexible in content and subspecialty based orientation.
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