The Department of Radiology of the University of Michigan offers a one-year fellowship in Musculoskeletal (MSK) Radiology. Four funded positions are offered each year. Non-funded fellowship positions are also offered and range from clinical to research positions. The emphasis of the fellowship is on achieving well-balanced, comprehensive subspecialty training in all areas of MSK Radiology. It is intended that the intensive MSK Radiology experience at the University of Michigan prepare the fellow for a career in subspecialty MSK Radiology, either private practice or academic.
The Department of Radiology at the University of Michigan Hospitals is the primary department responsible for diagnostic imaging at the University's medical center, which includes 865 hospital beds and a large outpatient facility. The range of clinical material available is reflected in the diagnostic patient load of approximately over 500,000 examinations yearly.
The MSK Radiology Division provides full musculoskeletal imaging services, including digital radiography, fluoroscopy, computed tomography, magnetic resonance imaging, and sonography. The MSK Radiology Division performs bone and soft tissue biopsies, aspirations, diagnostic and therapeutic injections of joints, and arthrography. The Department of Radiology has state-of-the-art equipment and high quality technical and ancillary staff. The MSK fellowship at the University of Michigan is one of the few that includes training in musculoskeletal sonography.
At the University of Michigan, we see a wide range of musculoskeletal pathology, as our patient population ranges from primary care to tertiary care. Notable areas include orthopedic trauma, soft tissue and bone tumors, and rheumatologic disorders. In addition, the sports medicine physicians support the collegiate athletes from the University of Michigan, which provides exposure to sports-related musculoskeletal pathology. MSK fellows and division members participate in numerous intradepartmental conferences as well as interdisciplinary working conferences.
Teaching is highly valued by MSK division members, as shown by the Division's top rating in this area by its Radiology residents. Fellows are also provided a series of weekly didactics taught by the faculty. Fellows are encouraged to develop their own teaching style, and to participate in local, regional, and national conferences. Funding and time off are provided for such participation. The faculty are actively engaged in clinical research and strongly encourage fellows to become involved in research projects, culminating in presentations at national meetings and publications in major journals. Academic time, mentoring by faculty members and quality ancillary support are provided to promote a rewarding academic experience.
The MSK Fellow works closely with MSK faculty members in clinical work, with progressive independence as his/her experience grows. Fellows will develop the comprehensive technical and consultative skills needed to successfully manage complex musculoskeletal imaging cases. The atmosphere is professional, yet friendly, and promotes the highest quality in clinical services, teaching, and research.
During the one-year fellowship in Musculoskeletal Radiology, each fellow will expertise in musculoskeletal MRI, CT, US, radiography, and interventional procedures. Through hard work, education, and sharing of responsibilities, our fellows emerge from their training as well-rounded MSK consultants, equipped with the knowledge and experience that will allow them to succeed in any type of practice, clinical or academic. We emphasize the team approach to our division, with the goal of completing the daily work in an efficient manner in an atmosphere that is positive, supportive, friendly, and educational.
As junior faculty at the University of Michigan, fellows have gradually increased clinical responsibilities throughout the year. The faculty and each fellow decide when the time is right for this transition. Limited independent interpretation of radiographs usually begins in the Fall, followed by other imaging studies when the fellow is comfortable. At all times, there are several MSK faculty present to assist with difficult cases and consultations. We encourage fellows to strive to continually improve speed and accuracy of interpretation and dictation as they progress through the fellowship. We have developed a fellowship-level MSK curriculum based on the ACGME core competencies to serve as a guide for independent study. In addition, the faculty teach a series of weekly didactics and seminars geared to the fellowship level, to augment material learned in the daily readout sessions.
Resident teaching is integral to Fellow education. Fellows teach in conference format and one-to-one at the workstation during read out and during procedures. Starting in August, each fellow will be asked to give resident teaching conferences throughout the year. In addition, each fellow will be asked to lecture to the Orthopedic residents at the end of the year.
Fellows staff interdepartmental conferences and sarcoma board, paired with faculty. These experiences help the Fellow to develop confidence and expertise at the expert consultant level.
Research is an important aspect of a truly well-rounded fellowship; however, we are realistic in that fellows are only here for 1 year. We encourage all fellows to participate in research of all types, and we provide time off the schedule (PD or professional development time) to do so. The level of participation in a project may vary depending on interest. If a Fellow is considering academics, the Fellow will have the opportunity to develop a research or educational project as the primary investigator. Each of the MSK faculty has numerous research ideas that are available. If a Fellow wishes to pursue private practice, then the Fellow may wish to participate in a project as a second or third author, performing data search and image interpretation, or pursue quality improvement programs (reviewing missed cases or performing follow-up) that are beneficial to the division and the Fellow’s future practice. Other possible educational experiences include an opportunity to rotate in an orthopaedic clinic, or to scrub in on a surgery or arthroscopy. Cadaveric specimens are available for dissection. A fellow may also spend some time in other divisions in the University of Michigan Radiology Department, as well as in Orthopaedic Surgery. These opportunities should be arranged with the division director.
Monthly Fellow schedules are integrated into the faculty schedule and can be viewed from the internal web site. The following is a general overview of the musculoskeletal Fellow schedule:
General: Check in with daily assigned bone faculty for details. The day begins at 8 a.m. A majority of our work is “on-line,” interpreting imaging studies immediately after they are completed. We empty the film requisition bins at 5:00 each day and complete that work before departing. Dictations are completed using voice recognition.
Inpatient MRI/CT and CT: This rotation is staffed by 1 faculty, 1 fellow, and 1-2 residents. Inpatient and ED cases interpreted first, followed by CT and routine MRI. MRI and CT protocols should be completed first thing in the morning, and then completed as they arise during the day. Outpatient MSK ultrasound cases are performed throughout the day. The fellow is encouraged to get as much “hands-on” scanning practice as possible.
In-Patient Procedures: One faculty, 1 fellow, and 1 resident cover this rotation. We average 1-2 CT or US guided biopsies per day; these occur in the mornings. MSK faculty supervise all biopsies. We average one osteoid osteoma ablation every 2-3 months. Inpatient US requests, and elective outpatient US injections are also performed on this rotation.
Outpatient MRI, Radiographs and Arthrography: One faculty, one fellow or PA, and one resident staff this rotation. 3-8 joint injections and MR arthrograms are performed per day. Radiographs, CT and MRI from the outpatient clinics are read throughout the day.
Professional Development (PD) / Conferences: Ample PD time is given to fellows to prepare for tumor board. Other time can be used for research, education, dissection, Orthopedic or other Radiology rotation, and participation in image interpretation sessions with faculty. Every attempt will be made to give professional days off the schedule, although this depends on how many fellows are on the schedule each week. The fellow should be available by pager during this professional day, and is expected to attend the daily 12:30 working conference. The Division Director must approve activities outside of the bone reading area.
Conferences: Several conferences that are considered essential to a fellow’s education and are considered mandatory (unless performing a procedure). These include the Tuesday 12:30 pm teaching conference, the Wednesday 7:30 am teaching conference, the daily 12:30 pm working conference, the joint Orthopaedic Resident conferences, and the sports medicine conference. Optional conferences (when not assigned) include Sarcoma tumor board, Myeloma conference, and Rheumatology conference. See staff for details.
Additional Educational Meetings: These occur sporadically and are considered mandatory. Examples include journal club and the Southeast Michigan / Northwest Ohio Case Conference. Happy hours are optional.
The Musculoskeletal Faculty have diverse backgrounds and diverse research interests. Areas of research interest include but are not limited to MRI, ultrasound, cadaveric studies, comparative anatomy, arthritis, sports medicine, pelvic floor imaging, bone mineral density and metabolism, osteoarthritis, and procedures. Collaboration with Orthopaedic Surgery and Rheumatology, among others, is common with most research projects. Please see the individual Musculoskeletal Faculty web pages for specific research interests. Musculoskeletal Fellows and Residents often work with Musculoskeletal Faculty on research projects, which are expected to result in exhibits, presentations, and manuscripts. The Musculoskeletal Faculty will serve as mentors for such projects, and provide guidance to achieve such results.
We support the NRMP MSK Fellowship Match for the fellowship year 2020-21. The MSK match will follow the same timeline as Breast Imaging, IR and Neuroradiology fellowships. We will start reviewing applications in the winter and plan to hold interviews in April 2019.
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