Is it time to kiss the 'clinical year' for rad residents goodbye?

According to a recent commentary published by Academic Radiology, it’s time to bid farewell to the initial “clinical year” U.S. radiology residents are required to complete before beginning their four-year diagnostic radiology residency.

Authors Richard B. Gunderman, MD, PhD, and John P. Tobben, MD, of the Indiana University School of Medicine department of radiology, said common arguments in favor of the clinical year “are doubtful and have become more so over time.”

For example, proponents of the extra year argue that it helps trainees grow more comfortable with difficult decisions. Gunderman and Tobben countered that modern medical school does a more-than-adequate job in this regard.

“Medical school curricula now include specific courses on such topics as end-of-life care, breaking bad news, and emergency response in the form of training in cardiopulmonary resuscitation and advanced cardiac life support,” the authors wrote. “Courses in ethics and professionalism have become standard in medical schools, and medical students gain experience in handling emergency situations through rotations in intensive care and emergency medicine. Prospective radiology residents who are not required to take such courses can be told that they must enroll in these electives.”

Proponents of the clinical year also say it it helps residents develop certain clinical skills, but Gunderman and Tobben once again pointed to medical school, saying students already have an abundance of opportunities to focus on any specific clinical skills.

“At many medical schools across the country, the fourth year has become largely elective, and most fourth-year students have 6–9 months to choose what courses they will take,” the authors wrote. “Again, students can simply be informed of the courses they need to complete to prepare for diagnostic radiology residency.”

Gunderman and Tobben also listed specific reasons why the requirement should be eliminated. For example, they said the name “clinical year” makes it sound as if the next four years of residency training are not, in fact, clinical. And it may even give one the impression that radiologists are “nonclinicians”

The authors also explained that adding an additional year to a radiologist’s training when it is not absolutely necessary harms that individual financially.

“Consider, too, the opportunity cost of such a year,” the authors wrote. “Each additional year of training is a year of lost income as a practicing radiologist. Assuming that the average annual income of a practicing radiologist is on the order of several hundred thousand dollars per year, each radiology resident who completes a transitional year has not only suffered a reduction in lifetime earning potential approximately equal to that figure, but also accrued another year's worth of interest on medical school debt.”