Differences in Neuroradiology Training Programs around the World

BACKGROUND AND PURPOSE:No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites.MATERIALS AND METHODS:Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies.RESULTS:While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%).CONCLUSIONS:There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally.

The United States considers itself a leader in medical education and training among nations.¹ Generally speaking, American medical school, residency, and fellowship programs are considered globally as being well-structured, highly competitive, and outstanding in the quality of education and instruction. As of the 2013–2014 academic year, 185 radiology residency programs and 85 neuroradiology (NR) fellowship programs in the United States are voluntarily supervised by the Accreditation Council for Graduate Medical Education (ACGME). This private, nonprofit organization sets educational standards and periodically reviews their implementation within the respective graduate medical education programs.² In addition, completion of programs accredited by the ACGME is a prerequisite to becoming board-certified in diagnostic radiology and subspecialty certified in neuroradiology. Examinations are offered by the American Board of Radiology annually through the American Board of Medical Specialties. It oversees specialty and subspecialty certification in radiology and 23 other medical specialties in the United States.The educational path for an aspiring American neuroradiologist typically begins by matching in a first-postgraduate-year prerequisite clinical year (internship year) and an ACGME-accredited postgraduate year 2- to 5-year diagnostic radiology residency program.³ The first 3 years of residency focus on diagnostic radiology (postgraduate years 2–4) and include 9 core rotations in abdominal radiology, breast imaging, cardiothoracic radiology, musculoskeletal radiology, neuroradiology, nuclear radiology, pediatric radiology, sonography, and vascular and interventional radiology. In postgraduate year 5, residents may participate in subspecialty rotations of their choice.⁴ The trainees'' diagnostic experience in the different imaging modalities is assessed through a case/procedure log system, which is annually reviewed by the faculty of the program and the ACGME.⁵After finishing residency, graduating radiologists have the opportunity to start additional fellowship training within their discipline of choice if they desire subspecialty expertise.⁶ Contributing factors that promote the implementation of fellowship programs in radiology are the rapid development of new imaging techniques, the need for appropriate interpretation skills and expertise to compete in the job market, and the trend toward endovascular and percutaneous therapies.¹The first NR fellowship positions were offered in Stockholm and London in the 1950s and approximately 10 years later in New York (1960).⁷ Regarding neuroradiology, 2 fellowships are offered in the United States currently: diagnostic neuroradiology (DNR) and interventional neuroradiology (INR), with the latter, by ACGME regulations, requiring a previous DNR year. However, very few of the offered neurointerventional programs are currently ACGME-accredited, so this requirement is often not completed.Because there is a trend toward greater subspecialization in radiology globally, we conducted a survey to investigate differences in radiology training programs across the world with regard to the general curriculum, focusing on neuroradiology fellowships in particular. Therefore, departments in countries on all continents were asked to complete a standardized questionnaire about their training programs. Hence, differences in international educational structures could be revealed.