is the Editor-in-Chief of this journal and a Professor of
Radiology, Diagnostic Imaging Department, University of Maryland
Medical Center, Baltimore, MD.
Sometimes, in the evenings, I like to share stories about my
residency days with our current on-call radiology residents. I do
this both for entertainment purposes (mine and theirs) and to
convey some sense of how "good" the residents have it today. You
see, most of us seasoned radiologists, I believe, recall their
residency training as being more difficult, demanding, and
challenging, etc. than today's training programs. This presumption
is a source of pride, a badge of honor in having successfully "run
When I tell my stories of 25 years ago, I always mention the
limited space, outmoded equipment, lost films, tyrannical and often
bizarre-acting faculty, 36-hour shifts, and combative teaching
conferences, among many other complaints about my training. Some of
my stories really get the residents' eyes wide and mouths agape.
Some stories they just can't believe. I feel like I should beat my
chest after recounting the worst of it.
Actually, upon further reflection, though, I believe I had it
much easier than the residents of today. I walked into the
Chairman's office in 1980 with barely an appointment. Since I had 2
eyes, could hold a mostly sane conversation, and graduated from a
medical school he had heard of, I was accepted into the program on
the spot. Today, every candidate for residency is in the top of
their class, charming, refined (well, not all), and usually has an
Olympic medal or papal recommendation. The competition is fierce at
While I worked 36-hour shifts, typically 4 to 5 of those hours
were spent sleeping. Our residents now work on a "night-float"
schedule but don't sleep, at least not intentionally. While
on-call, I was able to run off for an hour and play
online (yes, there was a limited online capacity even then) without
difficulty or complaint. Today, with so much of medical care
centered on diagnostic imaging, the telephone rings and pages in
the Emergency Room are constant. I was responsible for covering 1
hospital on-call; our residents now cover 4. Most of the imaging
studies requested during my residency had some rational indication;
in today's litigious environment, a valid indication is a more
welcome event. I could actually say "no" to a requested study or
"it will be done tomorrow" and have it stick. Today, only the
bravest residents even attempt that. Usually, my faculty backed me
up in my on-call decisions. Today, the faculty usually leans toward
giving in to our "customers" without argument.
The current department has ample space, top-of-the-line
equipment, large reading rooms "of the future," a resident lounge,
a highly regarded (only slightly peculiar) faculty, and much more.
On the other side, today's residents have whole new technologies to
quickly learn (MR, PET, MDCT, SPECT, Doppler and Power sonography,
etc.). The knowledge base required for radiology has grown
extremely rapidly and continues at that pace today. Much of this
new information is not basic science detail but is required for
daily clinical practice. Finally, I believe, at baseline there is
an expectation of routinely excellent performance, leaving little
room for rough spots during residency training.
I have a lot of respect for our residents and those I typically
encounter as a visitor to other departments. I think they function
at a considerably higher level than I needed to when I was a
resident and constantly meet enormous intellectual and emotional
demands. So if you think radiology residency training was really
tough in the old days, I believe it is a lot tougher now. Perhaps,
it's a sentiment to keep it in mind the next time one of your
residents lets you down a bit.