Residents gain invaluable experience, confidence, and independence as they progress through the tiered call system. The robust on-call experience is designed to fully prepare residents for all aspects of radiology, including both the private practice and academic settings. Residents repeatedly say that their on-call experience is one of the most useful and rewarding learning experiences of residency.
Residents taking junior call independently interpret radiographs and nuclear medicine scans for both adult and pediatric emergency room patients and inpatients. They also independently perform urgent fluoroscopy exams, including image-guided lumbar punctures. Preliminary reports are dictated into the electronic medical record prior to being finalized by the attending later in the shift or the next morning. Volume averages 80-120 radiographs, 0-2 nuclear medicine scans (predominantly HIDA and V/Q scans), and 0-2 fluoroscopic exams over the course of a full 11 hour shift.
Residents gain experience in the junior call system in the spring of their first year, when they shadow a senior "buddy resident" to learn the system. First-year residents also work with attending supervision on several short shifts in the evening hours. During the second year, residents do are assigned to 4-5 weeks of independent, overnight junior call along with scattered daytime weekend shifts and short (5-hour) evening shifts. A week of overnight junior call is repeated in the final year of residency to help senior residents refresh their basic skills.
Residents taking senior call independently interpret cross-sectional studies (US, CT, or MRI) across every subspecialty for both adult and pediatric emergency room patients and inpatients. They dictate preliminary reports containing urgent findings into the electronic medical record. Senior on-call residents are also responsible for protocoling urgent cross-sectional exams, responding to contrast reactions and extravasations, and checking technologist-performed US exams and trauma CT scans for quality control. Two reading room assistants are always present during call shifts to help answer the phone and to facilitate imaging-related requests. Volume averages approximately 70-100 cross-sectional exams over the course of a full 12 hour shift.
Residents are assigned to 2 weeks of senior call in the second half of their second year, 4-5 weeks during their third year, and 4 weeks during their final year. Residents also cover scattered daytime weekend shifts and short (5-hour) evening shifts. These weeks are a mix of evening and overnight shifts and are tiered so when junior residents are assigned to these call shifts they are paired with senior residents for support.
Residents on call are given autonomy to make independent interpretations; however, supervising faculty are immediately available when needed. An Emergency Radiology faculty member interprets cases only after resident preliminary reports are rendered. Subspecialty faculty are also available for consultation by phone or pager 24 hours a day.
Graduates of the residency program have reported that they are supremely confident in their ability to work independently during fellowship and when entering private or academic practices. This in large part is because our residents are provided an opportunity to make independent decisions even on complex cases throughout their residency training.