Radiology training in United Kingdom: current status
Introduction
Clinical radiology has always been one of the most competitive specialties as it attracts a diverse range of junior doctors who are searching for a life of exciting diagnoses, cutting edge technology and minimally invasive procedures. Traditionally entry into radiology training followed the completion of postgraduate medical or surgical exams, such as Membership of Royal College of Physicians (MRCP) or Membership of Royal College of Surgeons (MRCS), however the implementation of Modernising Medical Careers has meant that candidates are able to apply after completing their 2 years of postgraduate foundation training.
Due to the increasing demand for radiology services the number of training posts in the UK has been increased. In 2014 there were 228 training posts available which received 798 applications (1).
Training is delivered via 18 different deaneries geographically situated throughout UK. The majority of deaneries deliver a traditional apprentice model of training, however a few new training schemes follow an academy model with more focused curriculum driven teaching during the early core years (2).
The structure of training
Clinical radiology training takes 5 years and requires completion of the Fellowship of Royal College of Radiologists (FRCR) exams, adequate evidence to demonstrate completion of the curriculum and successful appraisals. Successful completion leads to a Certificate of Completion of Training in Diagnostic Radiology. Interventional radiologists often complete 6 years of training which leads to a Certificate of Completion of Training in Interventional and Diagnostic Radiology.
The first 3 years of training are dedicated to developing all the general core skills a radiologist requires, in addition to gaining a brief experience in each of the subspecialties. During this time trainees’ continue to sit their FRCR Part 1 and FRCR 2A subspecialties modules.
At the end of 3 years training, the trainees’ are expected to have completed the FRCR Part 1 and Part 2A and should show evidence to have completed the majority of the core curriculum.
Years 4 and 5 are dedicated to sub-specialty training. Trainees choose their specific area of interest and dedicate the majority of their time to this. By the end of this period trainees are expected to be proficient in sub-specialty reporting, related practical procedures and the ability to lead a multi-disciplinary team meeting.
The 5 years training program is an exciting and challenging journey. Clinical supervisors and trainers find it extremely rewarding to see the transition of their trainees from junior doctors to more autonomous senior registrars.
Exams
The FRCR is a compulsory part of UK radiology training. The exams are challenging and set the standard for general radiology reporting in UK and other areas of the world. The qualification consists of 3 parts.
The FRCR Part 1 is 2 modules, physics and anatomy. The physics module covers all the basics of radiological physics and the exam is true or false questions. The anatomy module requires candidates to have a firm knowledge of radiological anatomy on all modalities and all body regions. It is tested via radiological images displayed on a screen with arrows directed to certain structures and candidates write down the specific answers.
When trainees have completed Part 1 they move onto Part 2A, which is made up of 6 modules covering all the radiological subspecialties. The modules are chest, musculoskeletal, gastrointestinal, genitourinary, paediatrics and neuroradiology. Each module has a 75-question single best answer examination.
The third and final set of exams is the FRCR 2B, which consists of 3 discrete parts all carried out over 2 days. There is a viva, rapid-reporting section and long case section.
Upon completion of the FRCR 2B exam candidates are admitted as Fellows of the Royal College of Radiologists, UK (3).
On Call
After completing a year of radiology training, registrars (trainee doctor or medical officer in UK) are eligible to enter an out of hours on call rota. This exposes trainees to a volume of emergency cases and develops autonomy, communication and decision making skills. Depending on the size of the hospital being covered there are usually one or two registrars on call covering emergency computed tomography (CT) and ultrasound (US). Preliminary reporting is completed by the registrars after which consultants review the images and issue a final report.
Life after training
On completing training and receiving the Certificate for Completion of Training (CCT) a select proportion of trainees choose to embark on a fellowship program. This gives trainees the opportunity to further develop their subspecialty interest generating a high level of confidence in diagnostic and procedural skills. During this time research methods can also be developed leading to university qualifications and peer-reviewed publications. British trainees can stay in UK to complete their fellowships but many choose to travel abroad to countries such as Australia, Canada and New Zealand. On completion of these fellowships trainees are usually well equipped with the skill set to work in a UK based district general hospital or tertiary centre.
Disclosure: The authors declare no conflict of interest.
References
- 2014 Specialty recruitment competition ratios. Available online: http://specialtytraining.hee.nhs.uk/specialty-recruitment/competition-ratios/2014-competition-ratios/
- Society of Radiologists in Training AGM 2014. Available online: http://www.thesrt.co.uk/
- The Royal College of Radiologists. Examinations. Available online: http://www.rcr.ac.uk/content.aspx?PageID=2233
