Combined fellowships

[MedHopeful2395]

Hi all,
I’m a PGY1 radiology in a canadian program and I hoping to get your thoughts on combined fellowships. I have come across fellowships that combined for example Body and MSK (with focus on MRI) or neuro and MSK etc. I might be naive but I feel like for 1 year long fellowships that are on a single organ system, your learning may plateau by about midway through so I feel like these combined fellowships are great to optimize your learning and be more marketable. Am I missing something?

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[maxxor]

Hi all,
I’m a PGY1 radiology in a canadian program and I hoping to get your thoughts on combined fellowships. I have come across fellowships that combined for example Body and MSK (with focus on MRI) or neuro and MSK etc. I might be naive but I feel like for 1 year long fellowships that are on a single organ system, your learning may plateau by about midway through so I feel like these combined fellowships are great to optimize your learning and be more marketable. Am I missing something?

Everything old is new again, unless it was just old and never updated.

Once upon a time, Modality fellowships were a thing. These arose because certain modalities were uncommon in traditional residencies. There were ultrasound, CT, and MR fellowships. Then once those became widespread, academic departments started organizing around organ systems and it made more sense to do organ system fellowships.

IMO Modality fellowships make sense really only in a research context: you want to do advanced MR sequence research etc. Clinically, the value of a specialized radiologist is that you can use all modalities in the evaluation of a given organ system's pathology. It doesn't really make sense to be an "MR Guy" who reads breast MR but doesn't do mammo, who reads brain MR but doesn't do neuro CT, and who does MSK MR, but doesn't do the other stuff. You also are not eligible for any ABR CAQs going that way (neuro), which reduces your marketing value for a group in the eyes of referrers.

Some Residency programs have enfolded fellowships. I went to one. That makes more sense for the creation of "multi-specialty" radiologists than these modality fellowships. I'd argue perhaps the only "fellowships" where you can get away with 6 months of learning would be abdominal and breast. The rest you actually need the year.

 

[guytakingboards]

Hi all,
I’m a PGY1 radiology in a canadian program and I hoping to get your thoughts on combined fellowships. I have come across fellowships that combined for example Body and MSK (with focus on MRI) or neuro and MSK etc. I might be naive but I feel like for 1 year long fellowships that are on a single organ system, your learning may plateau by about midway through so I feel like these combined fellowships are great to optimize your learning and be more marketable. Am I missing something?

You're not wrong to say the learning curve starts to flatten in the 4-7mo range. Everything after that *is* lower yield. That being said, those lower yield reps are critical to the development of the subspecialist.

Take a neuro fellowship: in 4-6mo you should be comfortable (and fast) with stroke, trauma, degen, glioma's and basic H&N cancer. It may take those extra 6 mo's to see enough cases to feel comfortable temporal bone/inner ear, peds/congenital neuro, orbit, advanced H&N cancer, brain/spine infection, advanced modalities (fMRI, ASL, perfusion, DTI, etc...) . Those extra reps also help lock down the basic neuro category. Over the entire year you get enough reps to see common things like MS and glioma through from de novo dx through post-treatment follow-up.

In the last few months on call, I've had de novo GBM and ADEM on non-con stroke CT's. I had no problem saying calling the first one GBM on the non-con CT and the second one certain demyelination rather than "mass" and "indeterminate hypoattenuation". Referring clinicians appreciate a sub-specialty read, on both simple and complex cases.

With two 6-mo fellowships, I think you're a super helpful person to be on shift with. Yet, I think the clinicians want the full-sub spec read every time if they can get it. Basically: jack of all trades, master of none.

 

[Tiger100]

You're not wrong to say the learning curve starts to flatten in the 4-7mo range. Everything after that *is* lower yield. That being said, those lower yield reps are critical to the development of the subspecialist.

Take a neuro fellowship: in 4-6mo you should be comfortable (and fast) with stroke, trauma, degen, glioma's and basic H&N cancer. It may take those extra 6 mo's to see enough cases to feel comfortable temporal bone/inner ear, peds/congenital neuro, orbit, advanced H&N cancer, brain/spine infection, advanced modalities (fMRI, ASL, perfusion, DTI, etc...) . Those extra reps also help lock down the basic neuro category. Over the entire year you get enough reps to see common things like MS and glioma through from de novo dx through post-treatment follow-up.

In the last few months on call, I've had de novo GBM and ADEM on non-con stroke CT's. I had no problem saying calling the first one GBM on the non-con CT and the second one certain demyelination rather than "mass" and "indeterminate hypoattenuation". Referring clinicians appreciate a sub-specialty read, on both simple and complex cases.

With two 6-mo fellowships, I think you're a super helpful person to be on shift with. Yet, I think the clinicians want the full-sub spec read every time if they can get it. Basically: jack of all trades, master of none.

You should be comfortable with stroke, trauma, degen, glioma and basic H&N by the end of third year of residency. Otherwise, there is something wrong with your residency teaching.

Except for IR, 6 months is enough for all DR fellowships unless you didn't have a solid training in residency.

Don't forget that there was a time that most academic neurorads believed that neuro fellowship should be 2 years. IMO, that is a total waste of time.

 

[guytakingboards]

You should be comfortable with stroke, trauma, degen, glioma and basic H&N by the end of third year of residency. Otherwise, there is something wrong with your residency teaching.

Except for IR, 6 months is enough for all DR fellowships unless you didn't have a solid training in residency.

Don't forget that there was a time that most academic neurorads believed that neuro fellowship should be 2 years. IMO, that is a total waste of time.

I meant sub-specialist level at that stuff, which obv a 3rd year resident wouldn't be. They might be generalist level, which is good enough... for the basic stuff.

The 2-year neuro fellowship was a relic of the angiography requirements. Those fellowships used to be much more procedurally based. Once that stuff got carved out to NIS, most everyone realized there was no reason to do 2-year fellowships.

 

[MedHopeful2395]

Thanks for the responses guys! I guess there’s different opinions around this eh. I am hoping to work hard during residency and try for a combined fellowship so I have multiple areas of expertise in a more community/PP setting.

But I guess it’ll depend on my comfort level going into R3 when i’m applying for fellowships. I just wanted to ensure it wasnt looked down on upon when applying for jobs.

 

[Tiger100]

I meant sub-specialist level at that stuff, which obv a 3rd year resident wouldn't be. They might be generalist level, which is good enough... for the basic stuff.

The 2-year neuro fellowship was a relic of the angiography requirements. Those fellowships used to be much more procedurally based. Once that stuff got carved out to NIS, most everyone realized there was no reason to do 2-year fellowships.

What is the sub-specialist level at the level of basic H&N cancer and Stroke?

I know where you are coming from. Stop it.