How to turn your department into a radiology training reference centre A Self-Assessment Tool for Training Centres FOREWORD Education in medical radiology is one of the most important issues for the European Society of Radiology (ESR). Radiology training is generally provided by training centres; widely complemented by courses, conferences, publications and congresses, typically organised by national and international associations. The ESR has been actively providing tools for resident education, including the European Training Curriculum for Radiology; the European Training Assessment Programme (ETAP); elearning facilities, including self-assessment tools; the European School of Radiology (ESOR); and the European Diploma (EDiR). The main goal is to enhance the quality of radiological education by standardising radiological training. The European Training Assessment Programme (ETAP), a subcommittee of the ESR s Education Committee, aims to provide departments that give specialty training in clinical radiology with an objective assessment of their training programmes by ESR-nominated external assessors. Assessment is voluntary and requires effort and time from both parties. Training centres from many European countries have been assessed since 2001. Two assessors evaluate the structure and management of the training programme, the delivery of training and education, the radiology facilities and resources, and the outcomes during the visit (if the ETAP budget allows a third junior radiologist may be included). Conclusions are drawn and recommendations are provided at the end of the visit. ETAP also aims to develop assessment systems and guidelines for use by postgraduate education authorities at a national level. ETAP is now developing a self-assessment tool for training centres. This tool can be used as a basic guideline to help the departments evaluate their level of quality and motivate them to improve their training facilities. The expectations and recommendations in the guideline are compatible with the European Training Curriculum for Radiology and modern international educational references. The assessment is based upon a qualitative scoring system based on questions. Each item is answered with Yes or No. Items answered No can be considered an opportunity for problem solving. The assessment has five main categories that reflect the ETAP assessment structure. These include: 1. The structure and management of the training programme 2. The delivery of training and education 3. Radiology facilities and resources 4. Research facilities 5. The outcomes
Self-Assessment Questions 1. The structure and management of the training programme 1.1. Does the training centre have a written curriculum? 1.1.1. Is the written curriculum provided to the trainees at the beginning of training? 1.1.2. Is the curriculum compatible with the core national radiology curriculum? 1.1.3. Does the curriculum match the ESR s European Training Curriculum for Radiology? 1.1.4. Does the training programme match the ESR s 3+2 concept? 1.2. Is the department affiliated with a university? 1.3. Does the training centre have a full and close collaboration with a medical physics department? 1.4. Does the curriculum list the educational goals and objectives of the programme with respect to knowledge, skills and competences of residents at each level of training and for each major training task? 1.5. Is each learning objective in the curriculum matched with a learning methodology? 1.6. Does the training centre offer a specific assessment method for each learning objective in the curriculum? 1.7. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of radiation physics during the first three years? 1.8. Based on the curriculum, is it possible for trainees to acquire a satisfactory knowledge of the physical basis of image formation in all imaging techniques during the first three years? 1.9. With the help of the curriculum, is it possible for trainees to acquire a detailed knowledge of normal imaging anatomy in the early stages of training? 1.10. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of quality control and quality management during the first three years? 1.11. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of picture archiving and communication during the first three years? 1.12. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of radiation biology during the first three years? 1.13. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of radiation protection during the first three years? 1.14. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of the principles of molecular medicine with regard to imaging during the first three years? 1.15. Does the curriculum ensure that trainees gain knowledge of pharmacology, the application of contrast media, and the treatment of adverse reactions within the first three years? 1.16. With the help of the curriculum, is it possible for trainees to acquire a satisfactory knowledge of the fundamentals of clinical research and evidencebased medicine during the first three years?
1.17. Does the training centre provide good clinical competence in radiology training? 1.18. With the help of the curriculum, is it possible for trainees to acquire a basic understanding of computer science in the early stages of training? 1.19. Does the department have ready access to anatomy, biochemistry, statistics, legal physics and pathology university departments? 1.20. Is the spectrum of patient and investigative material available during training in the department sufficient to enable the trainee to gain experience in all fields of general radiology? 1.21. Does the curriculum include these modalities: conventional radiology, fluoroscopy, ultrasound, computed tomography or magnetic resonance imaging? 1.22. Does the curriculum provide a special course in emergency radiology during the early stages of training? 1.23. Are the residents trained in the identification and communication of urgent and unexpected findings? 1.24. Does the training centre emphasise the role of the radiologist in communicating with patients and families? 1.25. Does the training centre emphasise the role of the radiologist as a member of the clinical team and in collaborating with specialists from other disciplines in the treatment of patients? 1.26. Is the training centre involved in multidisciplinary and clinico-radiological conferences where the trainees improve their medical and decision-making skills? 1.27. With the help of the curriculum, is it possible for trainees to gain an in-depth insight into at least two subspecialties during the fourth and fifth years? 1.28. Does the curriculum provide an organ system-based organisation of rotations during the fourth and fifth years of training? 1.29. Does the curriculum provide trainees with lifelong learning skills? 1.30. Does the curriculum include a structured and continuous professional development programme? 1.31. Does the training centre use a logbook of activities during training? 1.32. Are all the competencies achieved and examinations performed by residents recorded? 1.33. Is the programme capable of providing a rotation in radionuclide imaging/nuclear medicine? 2. The delivery of training and education 2.1. Does the training centre have an orientation programme at the beginning of the training programme? 2.2. Are all the rotations organ system-based? 2.3. Does the programme contain a mixture of didactic lectures, tutorials and seminars? 2.4. Does the programme offer one-to-one apprenticeship relations with the faculty?
2.5. Is a local tutor, with direct responsibility for in-house training, appointed to ensure that the curriculum will be followed by trainees? 2.6. Does the training centre give trainees responsibility (on-call rotation) in emergency service before the end of the first year of training? 2.7. Do trainees have the opportunity to become involved in the radiological examination and diagnosis of patients presenting in the emergency department? 2.8. Does the training centre supervise all reporting through check-ups or double reading of trainees initial reports? 2.9. Does the training centre encourage trainees to attend external courses and scientific congresses? 2.10. Does the training centre encourage trainees to attend a minimum of two international and five national congresses or courses throughout the five years? 2.11. Does the programme promote the presentation of original research at scientific meetings? 2.12. Does the training centre ensure that outside meeting participation is logged and recorded on an annual basis? 2.13. Does the training centre conduct the assessment programme with academic radiologists who are not directly involved with the scheme under evaluation? 2.14. Does the training centre have regular assessments of educational activities on a yearly basis? 2.14.1. Is the assessment process coordinated through a national society or training body? 2.15. Does the training centre have a trainee assessment system that takes place at regular intervals? 2.15.1. Does the training centre take into account logbooks in assessment? 2.15.2. Do the assessments cover clinical and technical competencies, including interpersonal skills and suitability as a clinically active doctor? 2.15.3. As part of the assessment process, are the trainees given an opportunity to share their own observations on training facilities and teaching personnel on a confidential basis? 2.16. Does the training centre have an objective measurement (such as written exam, thesis etc.) of achieved standard at the end of training? 3. Radiology facilities and resources 3.1. Staffing 3.1.1. Is the number of qualified radiologists with teaching functions in the department sufficient to fulfil all the needs of teaching in each major subspecialty area? 3.1.2. Does the training centre have the resources to provide modular subspecialty training outside the hospital without special teaching staff? 3.1.3. Does the training centre encourage the academic staff to attend teachertargeted training courses? 3.2. Equipment
3.2.1. Is the department equipped with a sufficient amount of radiological equipment to fulfil the learning objectives of the curriculum? 3.2.2. Is conventional radiography available in the department? 3.2.3. Is fluoroscopy available in the department? 3.2.4. Is mammography available in the department? 3.2.5. Is angiography available in the department? 3.2.6. Is ultrasonography available in the department? 3.2.7. Is computed tomography available in the department? 3.2.8. Is magnetic resonance imaging available in the department? 3.2.9. Does the training centre have access to nuclear medicine? 3.2.10. Does the equipment comply with radiological safety standards, and is it in good technical condition? 3.2.11. Does the training centre meet the national quality control criteria for the technical efficiency, security, electrical control, and radiation safety of the equipment? 3.2.12. Is radioprotection organised and radiation monitored according to European standards? 3.3. Reading facilities and teaching materials 3.3.1. Does the training centre have a room suitable for meetings and conferences? 3.3.2. Does the training centre have access to quiet reading areas with computers and internet access for the trainees within the department? 3.3.3. Does the training centre have audio-visual equipment in the radiology department, sufficient to enable the implementation of the teaching programme? 3.3.4. Does the training centre have an adequate supply of teaching materials including textbooks, journals and e-learning material? 3.3.5. Does the training centre provide teaching facilities including access to online medical publications and teaching aids (including EURORAD etc.)? 3.3.6. Does the training centre have the computer technology for teaching, research purposes, image processing and communication? 4. Research Facilities 4.1. Does the training centre have an active and ongoing research programme at the training department? 4.2. Does the training centre encourage trainees to participate in the research programme? 5. Outcomes The revised European Training Curriculum for Radiology (available at http://www.myesr.org/trainingcurriculum) is the principal point of reference for outcomes. It provides both the trainees and the trainers with a detailed list of learning goals along with the knowledge, skills and competencies and attitude
required. Five-year training has been divided into two levels: Level I indicates the first three years of the radiology training. Level II refers to the fourth and fifth years. Each level has elements that represent learning modules mainly consisting of organ systems. Each element has been numbered separately and includes the lists of learning objectives for knowledge, skills, competencies and attitudes. Both the trainees and trainers may utilise each item to investigate the outcome. In this part of the self-assessment the training centres are advised to evaluate the outcomes by generating questions from the items mentioned above. Below a sample question has been given for the first item of the skills for breast radiology in Level I which has been numbered B-I-1 (p.25). - Is the student capable of performing ultrasound examination of the breast under supervision at the end of the third year? Questions for each part will be asked upon completion of the relevant level.