Fellowship

Corrie Yablon
Corrie Yablon, MD
Fellowship Director

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 for research or military applicants. Fellows receive well-balanced subspecialty training in all areas of MSK Radiology. Fellows emerge from the fellowship well-prepared for careers in private practice or academic subspecialty MSK Radiology.

The Department of Radiology at the University of Michigan/ Michigan Medicine is the primary department responsible for diagnostic imaging at the University's medical center, which has over 1000 hospital beds and a large outpatient facility. The radiology department performs almost 700,000 exams per year.

The MSK Radiology Division provides comprehensive 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 quaternary care. Notable areas include sports medicine, orthopedic trauma and joint reconstruction, soft tissue and bone tumors, and rheumatologic disorders. The sports medicine physicians support the collegiate athletes from the University of Michigan, and this provides exposure to a wide range of 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 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 complete range of 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.

Curriculum

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.

Conferences

  1. Tuesdays 12:00- 12:45 p.m.
    1. Faculty didactics for residents in Sept. – June. No noon conferences in July and August. Fellows are expected to attend this resident conference.
  2. Wednesdays 7:30 -8:30 a.m., Sept. – June.
    1. Fellow didactic case conferences for residents
  3. Daily 12:30 – 1:00 pm; (12:45 pm on Tuesdays)
    1. Daily working conference. Review of biopsy/ procedure requests, discussion of tumor board cases or other interesting cases.
    2. Every fellow should have at least one interesting case ready to share with the group
  4. Wednesdays, 4:45 pm – 6 or 7;
    1. Sarcoma multidisciplinary conference. Usually the on call fellow presents at tumor board.
    2.  Myeloma conference, and Rheumatology conference.  See staff for details.
  5. Last Tuesday of the month, 7:30 -8:30 a.m.
    1. Myeloma conference – MSK fellow runs the imaging portion of the conference.

Didactics

Fellowship-level didactics are taught by faculty throughout the year. These include practice teaching points at the daily “working conferences” and focused teaching sessions on advanced MSK concepts, including the following: fracture fixation, joint reconstruction, tumor and infection imaging, imaging of metal implants, sports medicine, interventions, MSK US didactics and hands-on training sessions, career planning and practice development.

Fellow Teaching

Teaching medical students and residents is an integral part of the fellowship, both in conference format and one-to-one at the workstation.  Fellows are assigned 7:30 a.m. resident teaching conferences from September - March. The preparation of conferences not only allows fellows to gain expertise, but to create a teaching file and talks, develop their own style of teaching, and increase confidence in public speaking. Faculty are available to help fellows prepare if there are questions.

  • Resident conferences – didactic case conference format. Fellows may present a topic of their choice. Residents prefer a hybrid case review/ didactic format focused on one topic. Residents do not find random case reviews that useful.
  • Teaching of residents and medical students at the work station. Every 2 weeks we have a rotating group of M2’s in the MSK reading room. We occasionally have M3’s and M4’s on electives, in addition to med students visiting from other institutions. Occasionally we have visiting international residents and faculty.
  • Interdisciplinary conferences
    • Sarcoma board (weekly)
    • Myeloma conference (monthly)
    • Others – Rheumatology, sports medicine, etc.

PD Time (Professional Development)

Fellows get 2-4 days of PD time per month, depending on staffing. In the beginning of the year, fellows will usually need one full day to prepare for sarcoma board; we usually give the Tuesday off to prepare before the Wednesday tumor board. PD time can also be used for the following:

  • Study
  • Talk preparation
  • Observation of procedures or readouts
  • Research, review article preparation, QA
  • Observation of orthopedic surgery
  • Cadaveric dissection is possible

Every attempt will be made to give PD days off the schedule, although this depends on how many fellows and faculty are on the schedule each week. The fellow should be available by pager during PD days, and is expected to attend the daily 12:30 working conference.  The Division Director must approve activities outside of the bone reading area.

Electives

  • UCSD Observership: We have an educational relationship with University of California, San Diego that allows our MSK fellows the opportunity to spend up to 2 weeks in San Diego observing MRI interpretation. In return, their fellows can spend up to 2 weeks observing musculoskeletal ultrasound. Check with Dr. Jacobson for dates and details.
  • One week elective/observership in other U-M Radiology divisions. These are tailored per fellow to afford additional educational experience prior to starting practice.

Call

Call involves 2 things:

  • Overnight pager call
  • Weekend readout.

Pager call entails answering all pages and assessing ED/inpatient requests for procedures, most commonly emergent hip/ shoulder aspirations. You will be paired with the same faculty for overnight backup/ questions and for weekend readout. In July, faculty will accompany the fellow for overnight procedures; however, the goal is for fellows to quickly transition to performing independently on call. A faculty will always be available for consultation/ difficult cases throughout the year.
If a fellow has to come into the hospital after midnight, the fellow will be able to catch up on sleep and come to work the next day at 12:30 pm. Simply email the Taubman faculty and fellows scheduled to work the next morning to tell them you’ll be late due to a midnight procedure.

The second component of call is weekend and holiday readout. Work begins at 8 am and ends in the afternoon when all cases time-stamped until 12 pm that day are read.

The call schedule is posted in QGenda. When assigned to a weekday, the pager call begins at 5 pm and ends at 8 am the following day.

Sign in and out of the MSK pager (33457) when starting and finishing call. Call 936-6268 to assign the pager.

Moonlighting:

Several moonlighting opportunities exist within the Department of Radiology.
1. Contrast coverage. We have several outpatient centers requiring paid radiologist CT and MRI contrast coverage.
2. MSK Moonlighting: The MSK division has its own internal moonlighting program for reading cases off hours. Fellows may participate if desired.
3. ED evening coverage: Moonlighting shifts from 6pm-1am are available to fellows who work in the capacity of staff radiologists in the ED.

Online Educational Materials

In the Fellows’ folder on the T drive, there is an articles archive, organized by body part, modality, procedures, medical education, etc. We try to continuously update the archive. In addition, there are:

  • Suggested reading list
  • ACGME core competency-based MSK fellowship curriculum
  • ACGME MSK Fellowship Milestones Assessment form
  • Other useful PowerPoint presentations

There are many great MSK textbooks available for free online through Taubman Library and Clinical Key through the UMich clinical homepage.

Evaluations

Each fellow’s progress will be discussed among the bone faculty during our monthly division meetings and any concerns will be shared with the fellow in real time.  In addition, comments will be gathered from our faculty, PAs, US techs, and clerks to be used to complete the MSK Milestones Assessment form. This form and fellows’ progress to date will be reviewed by Dr. Yablon with the fellow in December-January. At this time, formal feedback will be solicited from the fellows. Any additional meetings can be scheduled at any time as desired. We are here to help. Fellows will also fill out evaluation forms about faculty.

Benefits

Salary: Please see the following link: https://medicine.umich.edu/dept/radiology/education/residency/benefits

  • Comprehensive health insurance coverage including vision, dental, life, disability, and flexible spending accounts.
  • Every house officer is guaranteed membership to the UH South Wellness Center for $10 per month. The gym is open 24 open per day with a wide variety of strength and cardiovascular training equipment. The gym can be easily accessed before or after work, or even before starting a call shift!

Vacation and Meeting Time

  • 22 days per year for vacation
  • Paid major holidays include: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day after Thanksgiving, and Christmas Day, 
  • 4 “season” days to use either at Christmas or New Year’s week (use or lose them)
  • 5 days for conferences
  • 3 days for interviewing
  • Additional time may be available if presenting research
  • Additional ½ week to attend RSNA and ARRS (2 fellows must remain to staff the division; fellows decide among themselves how to split the weeks)
  • As clinical lecturers/junior faculty, fellows get 15 medical days per year to be used for the following: illness; preventive medical/dental appointments/procedures; maternity/paternity leave; and care for a sick child or parent.

Professional Development Account

A total of $2500 per year can be used to pay professional society dues, medical licenses, books, journal subscriptions, computer software, and travel funds for professional enhancement.  See Annie for details on how to submit expenses for reimbursement from your fund.  An additional $1500 is available once per year as a presentation bonus (when presenting research done at this institution only) at a national meeting.

Schedules

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:

Daily Schedules

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.

Research Opportunities

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.

Fellows are expected to participate in at least one type of project listed below. Reviews or QA projects tend to be easier to accomplish in one year.

Research projects:

  • Each faculty has several IRBs and projects in various stages of development
  • Fellows can participate in all areas of literature search, data collection and analysis and manuscript preparation (First authorship is not required if time is limited)

Education exhibits

  • Aim for the October deadlines to submit education exhibits, case of the day, scientific posters or abstracts to SSR, ARRS
  • RSNA deadline is in early April
  • ISS deadline is in May

Review papers

  • Many of our faculty are invited to submit review papers to various journals every year and they frequently offer first authorship to interested fellows

QA projects

Apply

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 accepting applications October 1. We will send invitations to interview in January and we plan to hold interviews in late March – April 2019. We will accept the SSR common application. Since ERAS does not support the MSK Match, please email the following documents directly to us:

  1. SSR common application form
  2. CV including USMLE scores
  3. Personal statement
  4. Three letters of recommendation. One of these letters should be from your Residency Program Director. Please have your letter writers email the letters directly to us.

Please send all documents via email to:

Annie Riddle
Program Coordinator
andrbald@med.umich.edu

Ph. 734-936-4365
Fax. 734-936-9723

Corrie Yablon, MD
Associate Professor
Chair, Residency Selection Committee
Director, Musculoskeletal Fellowship
cyablon@med.umich.edu