If you’re in medical school and deciding what you want to do with your life or have already made the smart decision to pursue radiology, this blog post is for you!
Here, I will share my experience as a former resident (and former chief resident) at the University of Michigan Health System and what, in general, you should expect when embarking on your journey to becoming a radiologist. The dim light at the end of the tunnel is finally going to brighten!
What is Radiology Residency?
Radiology residency is a postgraduate training program that provides radiology trainees with the means to learn diagnostic radiology and/or interventional radiology – it transforms a freshly minted doctor into a board-eligible (and eventually board-certified) radiologist.
Types of Radiology Residency
Radiology residency is a 5-year training program that includes an intern year and 4-5 years of radiology training, depending on whether it is a diagnostic radiology residency or an interventional radiology residency, which I’ll break down further.
Radiology residency underwent some pretty significant changes while I was a resident, converting into two separate pathways with both diagnostic radiology residency program and interventional radiology residency program options.
Radiology residency programs also come in two main flavors: academic programs and community programs. Regardless, all programs should be certified by the American College of Graduate Medical Education (ACGME). This isn’t the case for fellowship, but many fellowship programs are also ACGME accredited.
Diagnostic Radiology Residency Program
Diagnostic radiology residency programs account for the bulk of radiology programs as the vast majority of radiologists are considered “diagnostic radiologists.” This simply means that the primary focus for diagnostic radiology residents is on reading cases – the diagnosis aspect of radiology.
All diagnostic radiology residents will still be trained in basic interventional radiology procedures such as joint injections, paracentesis, lumbar puncture, chest port placement, biopsies, etc. and are exposed to more substantial interventional radiology procedures such as transjugular intrahepatic portosystemic shunt (TIPS) creation, angiogram/angioplasty, transarterial chemoembolization (TACE), etc.
Diagnostic radiology residency is a 5-year program with 1 year of internship and 4 years of radiology residency (the diagnostic radiology component is a four-year training program). Residents rotate through the various radiology subspecialties throughout their 4 years of training. The vast majority of diagnostic radiology residents pursue a fellowship in their area of interest such as breast imaging, pediatric imaging, abdominal imaging, etc.
Interventional Radiology Residency Program
Interventional radiology branched off within the past decade to allow for better specialization in interventional radiology and offer improved clinical training experiences to better prepare trainees for a successful career. Dedicated interventional radiology training programs are 6-year programs that offer early specialization in interventional radiology, include a more rigorous intern year, and are essentially inclusive of a fellowship.
Interventional radiology residents still receive diagnostic radiology training within their first 3 years of residency and take the radiology core exam in their third year. Following completion of their training, they take an IR/DR certifying exam.
Academic vs. Community Programs
There are two primary radiology residency training environments: academic programs and community programs. Every program will offer a slightly different training experience.
Not all programs have an affiliation with a pediatric hospital and may have away pediatric radiology rotations.
Academic Programs
Academic radiology residency programs are typically associated with a university hospital or medical school/ school of medicine (hence ‘academics’), which generally have access to more resources for research and education. Many academic programs are also considered ‘tertiary care’ and deliver higher specialized care, giving trainees access to a higher percentage of complex cases during their training. This may include certain types of cancers, organ transplants, interstitial lung disease, advanced surgeries, and more.
There is generally some expectation for residents to participate in research projects, educational exhibits, and conference attendance. This is perfect for residents interested in research and education.
Community Programs
Community programs typically have more emphasis on clinical practice and less opportunity for research projects. There is generally plenty of opportunities to create educational exhibits and present at conferences. Community programs offer very strong training in bread and butter radiology and give residents exposure to hybrid and private practice models.
Regardless of the training environment, all programs have the same program aims – to prepare you to pass your certifying exam and deliver excellent care to your patients.
What to Expect During Radiology Residency Training
Transitional / Internship Year (PGY-1)
Categorical residency programs have an intern year included and all 5 years of diagnostic radiology and 6 years of interventional radiology are included when you match into a categorical program.
Advanced programs do not contain an intern year. Medical students will choose an intern year separate from an advanced residency program and match into both programs. Intern year options include a preliminary year in internal medicine or general surgery or a transitional year program. Transitional year programs are generally a little easier with increased elective time and typically have rotations in internal medicine, emergency medicine, and possible family medicine or surgery.
This is referred to as your “Post-Graduate Year 1” year (PGY-1).
R1 Year (PGY-2)
If you thought you had to learn a lot in medical school, get ready to really start drinking from the fire hose! Radiology has a steep learning curve as you have to know a ridiculous amount of clinical medicine, the imaging appearance of innumerable disease entities, and more.
Fortunately, most faculty members have pretty low expectations for R1s, even in academic medicine. You will rotate through all of the core rotations, frequently in several week blocks, and some programs maybe even start call at the end of the R1 year, such as plain film call with more basic studies.
Your initial focus will be on bread and butter exams, radiographs, computed tomography (CT), ultrasound, and nuclear medicine exams. You may get some magnetic resonance imaging (MRI) exposure, but MRI is typically more of a focus in the remainder of residency. You will be given a description of your clinical responsibilities before each rotation to maximize your clinical experience.
You’ll participate in didactic lectures, most often in the morning or during lunchtime, where your attendings and fellow co-residents and fellows will spoon-feed you common, uncommon, and interesting cases.
Core Rotations
- Abdominal imaging (GI/GU; sometimes referred to as “body imaging”)
- Breast imaging/Mammography
- Chest imaging (cardiac/thoracic imaging)
- +/-Emergency radiology
- Interventional radiology
- Fluoroscopy (sometimes incorporated into abdominal imaging)
- Musculoskeletal imaging
- Neuroradiology
- Nuclear medicine/Nuclear radiology
- Pediatric radiology
R2 Year (PGY-3)
You’ll start off looking at the new R1s and realize how much you’ve learned in the past year! 🙂 Radiology faculty will begin to have higher expectations for your knowledge base and expect you to start picking up more complicated studies. Challenge yourself early and often! You want to see as much as possible while in training to best prepare you to be on your own.
R2 year revisits the core rotation and you further your knowledge within the core rotations. The early part of your R2 year generally doubles as call prep for more advanced call where you will be covering cross-sectional imaging (CT, MRI, ultrasound).