Musculoskeletal Radiology Fellowship

The Musculoskeletal (MSK) Radiology Fellowship at the State University of New York at Stony Brook is a one year full-time closely supervised training program at a designated Level 1 Trauma Center.  This program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Currently, there is one fellow per year. The curriculum has been developed to build upon the knowledge and skills learned during residency.  The overall goal is for the fellow to become proficient in musculoskeletal radiology and procedures as well as adopt life long learning and self assessment skills.  The fellow is able to pursue future positions in either an academic or private practice setting.

During this time period, the fellow is exposed to imaging and procedures as they apply to the musculoskeletal system with expected graduated proficiency to the level of a subspecialist.  The rotations and curriculum have been instituted to include clinical, technical-hands on experience, didactic teaching, as well as scholarly activity/research. The six competencies set forth by the ACGME are addressed and incorporated into the rotational goals and objectives.

The rotations include:

1. Plain radiography
2. Cross sectional imaging-MRI/CT
3. Procedures/interventional. This includes joint aspirations, therapeutic injections, arthrography, MR/CT    arthrography, image guided biopsies, aspiration/drainage (utilizing either fluoroscopy, CT, MRI, Sonography). Some exposure to radiofrequency ablation techniques, as cases arise, is anticipated.
4. Sonography (as it applies to the musculoskeletal system)
5. Nuclear radiology (as it applies to the MSK system), DEXA
6. Pathology - bone and soft tissue pathology
7. MRI physics/applications - (includes physical  principles, hardware, applications, newer pulse sequences,     on- site   teaching with  hands on MR scanning experience)
8. Scholarly activity/research

Active participation is expected in the following areas:

1. Teaching of Fellow/ Fellow as teacher
2. Journal Club
3. Sarcoma Tumor Board
4. Quality Assurance
5. Outpatient Imaging Center
6. Research and scholarly activity

Rotations are scheduled in half day and /or full day blocks.  Some rotations and cases are concurrent to assure adequate exposure and involvement in interesting or more infrequent cases. This method also more realistically simulates what is expected of a practicing radiologist after training.

Cases include:

1. Emergency Department(ED)
2. Inpatient studies
3. Outpatient studies. Outpatient imaging studies are performed at both the hospital and in the on-site Out-Patient Imaging Center (ACP - Ambulatory Care Pavilion)
4. Adult and pediatric cases

The program has been structured and organized based on the ACGME Program requirements, specific objectives and the interpretation of the ACGME general competencies.                                 

Overall goals of the program are to facilitate fellow learning with demonstration of proficiency in Musculoskeletal (MSK) Radiology and to adopt life long learning and self assessment skills.  To this end the fellow will:

1. Demonstrate mastery of the knowledge based curriculum;
2. Demonstrate proficiency in the protocol of cases and interpretation of cross sectional imaging studies of MSK system;
3. Demonstrate proficiency in the timely dictation of a concise accurate radiological report;
4. Demonstrate proficiency in performing procedures including aspirations, joint/therapeutic injections, arthrography, bone and soft tissue biopsies;
5. Communicate effectively with patients, families, peers, residents, and faculty, technical, nursing, and ancillary staff. Provide consultation with referring physicians and services;
6. Apply knowledge learned to support and justify the appropriate clinical indications for ordering and      performing radiologic studies pertaining to both basic and advanced musculoskeletal imaging;
7. Demonstrate proficiency in performing and interpreting MSK ultrasound examinations;
8. Demonstrate a responsible professional work ethic;
9. Demonstrate proficiency in the interpretations of plain radiographs;
10. Formulate and master teaching skills and facilitate the teaching of medical students, radiology     residents, rheumatology and orthopedic residents, as well as other professional;
11. Demonstrate active participation in the Quality Assurance (QA) and monitoring process;
12. Demonstrate confidence in the interpretation of Emergency Department (ED) emergent studies; 
13. Perform critical analysis of journal articles as well as the process of research for discussion and for Journal Club. Includes effective electronic literature review to justify, validate, and critically appraise;
14. Demonstrate mastery of the six competencies with knowledge of objective assessment methods as they apply to the program and its goals and objectives;
15. Active participation and experience in MSK research including the IRB process, human subjects training.  Preparation of an abstract, manuscript, or case report for presentation at Grand Rounds, or submission at a national meeting, peer reviewed journal, interdepartmental, or at the Department’s Annual Research Day;
16. Demonstrate proficiency in conference/lecture organization, PowerPoint preparation, and presentation;
17. Incorporate the goals and objectives into critical self assessment and lifelong pursuit of knowledge;
18. Develop tools and learning approaches to facilitate the continuous acquisition and use of knowledge.

The Program Curriculum (inclusive of clinical, technical skills, didactic component, knowledge based curriculum/ syllabus, fellow prepared teaching and scholarly activity/research) incorporates the 6 competencies with teaching and assessment methods. Outcome assessments are utilized for both fellow and program improvement.

The Program is organized as follows:

1. Initial needs assessment based on fellow’s baseline knowledge and experience
2. Rotational schedules
3. Program goals
4. Program objectives-based on rotational components
5. Knowledge (cognitive) based curriculum
6. Clinical, technical, and didactic elements.
7. General requirements and responsibilities of fellow
8. Instructional and teaching responsibilities of fellow (Fellow as teacher)
9. Fellow Learning portfolio and Case –procedural logs
10. On-call requirements
11. Faculty and 360 degree evaluations in addition to more task specific evaluations.
12. Fellow evaluation of Program and faculty.
13. Fellow self assessment
14. Program Director-Fellow meetings
15. Summative/final evaluation

The curriculum contains the following educational  components:

1. Clinical and didactic curriculum. Fellow should demonstrate at the conclusion of the program both cognitive and technical skills competency
2. Knowledge based curriculum (syllabus)
3. ACGME Competencies. The program has integrated the following competencies into the curriculum:
   1. Patient care.
   2. Medical knowledge
   3. Practice-based learning and  improvement
   4. Interpersonal  and communication skills
   5. Professionalism
4. Systems-based practice.

This one year curriculum includes the following basic divisions/rotations:

1. Plain Radiography (inclusive of bone physiology and biomechanics)
2. Cross sectional imaging (CT/MR/Sonography, MRI techniques/applications)
3. Interventional/procedures
4. Scholarly activity/research
5. Didactic- Fellow as learner and Fellow as teacher

There is exposure to Nuclear Radiology (to include DEXA) - 5 days and bone pathology via conferences and tumor board.

One half day per week is considered protected time for research and scholarly activity. Five additional days are allotted for elective time with the approval of the Program Director.

If interested , contact the Program Coordinator, Linda Erickson at 631-444-3580