Radiology Residency Chain of Command
No, we are not the military, but there is a radiology residency chain of command! Lots of different entities in radiology residency are responsible for your day-to-day activities and training. It is more than your faculty and program directors. In fact, it is a whole hierarchy. And, it is was not until later on in my career that I really understood the roles that each of these entities played in managing a residency program. But, it would have been nice to understand it all from the very beginning and know who to address for each radiology residency issue. To that end, in today’s post, I am going to define each of the different titles and positions in charge of your radiology residency training and describe the roles that they play. For fun, each role I will associate with a military position! Let’s start at the bottom and work our way up…
Radiology Resident (Private)
Radiology Chief Resident (Corporal)
Typically selected by the residents and/or program directors, this person is the first rung in the ladder of the radiology residency command (also previous discussed in a prior post). When there is a basic residency level issue or problem, he/she rises to the occasion. The chief resident is often responsible for scheduling, board reviews, interclass conflict, drinks with peers, performance issues, and noon conferences. Anything within the residency program that does not need to go to the attending level is under the purview of the chief resident. And, the chief resident is also responsible for communicating faculty related issues to the residents.
Radiology Residency Coordinator (2nd Lieutenant)
This is the person that is pretty much responsible for the day-to-day running of a residency program but is typically is an administrator and not a physician. Most residency coordinators make phone calls, transcribe letters of recommendation, report issues to the faculty, send out evaluations, deal with class conflicts, make sure that the learning portfolios are complete, arrange end of the year parties, and more. Some play a large role in admissions committee screening. And, the coordinator is often a first line resource for the radiology resident when they have issues with colleagues or attendings. The radiology residency coordinator is an integral part of a radiology residency. (I think of this person like the Class Mom/Dad)
Radiology Faculty (Captain)
Full-time faculty members are responsible for the direct and indirect supervision of residents. The ACGME guidelines require all faculty members to teach. In fact, there are certain minimum numbers of faculty members that are required in order to run a residency program. Teaching involvement, however, varies widely by each individual faculty member. All residents are expected to follow the lead of the faculty when it comes to reading, procedures, and training in any of its forms.
Radiology Section Chiefs (Major)
This designation can be a bit technical. Theoretically, the radiology section chief for a radiology residency program can be different from the head of the section in a department. However, these individuals run the individual subspecialty rotations for a radiology residency. Individual faculty members answer to their own respective section chiefs in one of many academic areas. The section chief may also perform many other duties such as setting up protocols for technologists, introducing new procedures, signing off on resident competencies and curriculums, making sure that the subspecialty curriculum is appropriate, and more.
Associate Program Director (Colonel)
Although not an official designation by the ACGME, the Associate Program Director is the second in command for running the residency program. If there are issues that can not be taken care of by the radiology chief resident, faculty, coordinator, or section chief, these problems fall into the lap of the Associate Program Director. He/she is also responsible for curriculum planning, enforcement of residency rules and regulation, maintaining education quality, dealing with residency conflicts, answering to both the program director and the residents and more. Responsibilities are often shared with the Program Director.
Program Director (1 Star General)
This is the individual that is designated by the ACGME as directly in charge of the residency program. He/she is ultimately responsible for most issues that occur during a radiology residency. In addition, the radiology residency Program Director signs off on each resident that he/she is competent to practice diagnostic radiology after graduation. Clinical activity for this individual varies widely depending upon the size of the program but most have some clinical duties. However, all Program Directors are responsible for monitoring the clinical teaching in the residency program and for administering the radiology residency. So, this person is ultimately responsible for a radiology resident’s training.
Radiology Department Chairman (2 Star General)
The Radiology Department Chairman is the head of the entire radiology department. This person is responsible for dealing with all faculty issues and indirectly will usually help with radiology residency administration issues as well. When there are complaints about individual faculty members, new radiologists to hire, budgeting, and high-level resident issues, this person steps in to help with managing the problem. Often times, the program directors will consult with the chairman prior to making important decisions. The chairman sometimes holds the purse strings for some residency programs.
Designated Institutional Official (DIO) And The Graduate Educational Committee (GME) (4 Star General)
The DIO is the head of the hospital GME Committee. The radiology residency program director answers to the DIO for program level issues and high-level resident issues. The types of issues that a DIO will often work with include accrediting individual programs, monitoring pass rates for programs, dealing with issues such as probation and suspension of individual residents, checking residency action plans, adding complements to residency programs, and more. He/she often gets involved in residency legal issues. And, this is just the tip of the iceberg. Typically, this is a full-time administrative position that is very busy! Individual programs bring many of these issues to the DIO’s attention and they are subsequently voted upon by the GME Committee for approval.
American Board of Radiology (ABR) (Military Service Chiefs)
The ABR is a private organization in charge of testing for minimum competency for the individual radiology resident. All radiology residents need to pass the boards administered by the ABR in order to become a board-certified radiologist. Although they are not directly in charge of residency issues, they do play an important role in determinating the curriculum for the individual radiology residency program since they create the board exams (the core and certifying examinations more specifically).
Accreditation Council For Graduate Medical Education (ACGME) (Chairman of the Joint Chiefs of Staff)
Now we are talking high-level!!! The ACGME is a governmental run body that is the watchdog of residency programs, in our case a diagnostic radiology residency program. This organization accredits each radiology residency program. They have the power to put a program on probation or suspension. As part of the ACGME, there are other committees such as the Radiology Review Committee (RRC) that are responsible for setting up the individual radiology residency guidelines and requirements. They are responsible for making the maximum duty hours, faculty requirements, and more. Overall, most residents do not have direct contact with this organization though it is crucial to follow the ACGME rules in order for the individual radiology resident to graduate from an accredited residency.
Now You Know The Hierarchy
That just about covers the basics of the different levels of responsible parties for a radiology residency program. Even though some institutions have additional positions that also play a role in managing a radiology residency, the ones I described are usually the most important. (Just don’t tell that to the research manager or the radiology liaison!) Additional levels can get quite complicated but at least you have the basics of who to turn to when you have a specific issue or question. Now you know your ABCs of the chain of the radiology residency command!!!