All radiology residencies have an Achilles heel. In the pursuit of creating an excellent education for all radiology residents, programs need to balance the “service obligations” with the “educational” environment. Now, there is a lot of debate about service exceeding education. But, we all know of rotations where the service obligations seem to outweigh what you may learn on rotation. You may have a mammography rotation where your attendings need you to complete all the needle localizations at the expense of learning diagnostic and screening mammograms. Or, perhaps, you have an interventional rotation where you can’t get into cases because the technologists need the residents to consent all the patients. Regardless, what do you do when you find yourself not receiving the education you think you should receive?
How To Improve A Rotation With Service Exceeding Education? A Playbook!
Step 1- Be Specific About The Problem Of Service Exceeding Education
The first thing you need to do is to be specific and write down the particular problems in the rotation. In other words, what are the educational circumstances that your program is not meeting? If you believe that the residents don’t have enough paracenteses, write that down. If you find that the nuclear medicine attending is never in the reading in the room or is not giving enough lectures, make sure to add that onto the list. Make sure you enumerate each of those problems. Eventually, you will want to address the issues with the educational committee.
Step 2- Cross-Reference with The ACGME Program Requirements
Next, check the ACGME program requirements. See if the problem is one that directly contradicts the philosophy and regulations of the program requirements. If so, write down how the issue interferes with the program’s goals. This step is critical because programs must fulfill their educational objectives to their residents. If they do not, programs can meet repercussions from the ACGME. At worst, the ACGME may not reaccredit your program until they comply. Some corrections can be costly. You can expedite change if you document how the issues may prevent the program from meeting the ACGME bylaws.
Step 3- Document The Issues And Provide Data
Now that you have the specific issues and why they may interfere with the program’s goals, create a data trail. For example, if you are not receiving the right number of conferences every week, document all the faculty’s conferences. Or, figure out what number per week you have been receiving or the rate of cancellation of lectures every week. You will need to have some hard data when the time comes to present the issues. Objective data helps because you can eventually factually show that the fix can improve the problem.
Step 4 – Create A Plan To Fix The Problem
Come up with a financial or educational plan to solve the problem. Say your program lacks a statistician and you need one to satisfy the research requirement, come up with the potential costs of hiring one for the hospital or the program. Of course, it is a good idea to meet with your faculty to figure out satisfactory solutions. As a resident, you may lack the experience to know some of the costs and problems that the institution may encounter when they attempt to fix the problem. So, gather a team of folks that do know more about the area you wish to improve.
Step 5- Formally Meet With The Program Director, GME Committee, Etc.
Since you have already enumerated the problems, figured out how they interfere with the program education/requirements, provided accurate, objective data, and created a plan to fix the problem, now is the time to meet with the appropriate committee. You should submit the initial run through to the education committee or the program directors at the program level. Here the committee can discuss the issues and enact a plan. If the solution is not amenable to being fixed at this level, the education committee can submit the plan to the GME level, hospital level, etc. Nevertheless, you need to formally present a plan so that the program or hospital can make a solution.
Step 6- Implement The Plan
Now that the institution or residency is backing the solution, you should be part of the team that seeks to implement the solution. Make sure that the plan is working as stated and followup to check for a positive outcome. Most of the time, you will find a reasonable solution for the previous issues. (But not always!)
Step 7- Document Outcomes
Now that your institution has “repaired” the problem, you still have more work to do. Make sure that the fix is not worse than the problem itself. It is therefore vital to objectively document how the changes to the program have affected the outcomes. If the hospital institutes a policy that faculty members that miss lectures will receive a pay cut and the lecturers continue to miss giving noon conferences, the fix was not an adequate solution. So, this step is crucial to show that you have a viable solution to your original problems.
Why Bother With All This Extra Work To Remedy Service Exceeding Education?
Well, the answer to this question relatively simple. Your radiology residency program is the foundation for your future career. And, if your education is not adequate, it will reflect in your future employment.
Furthermore, this learning experience is not only good for learning how to fix your residency. It is also a great way to learn the principles to enact change in any career stage. You can adapt the same steps to almost any situation where you want to enact helpful change. So, figure out those areas in your program where service requirements overburden learning and think about ways to enhance your residency rotations using this seven-step guide. It is an exercise worth the effort!
