Combined Mt. Sinai St. Luke

1
Combined Mt. Sinai St. Lukes-Roosevelt4-year
Diagnostic Radiology/Nuclear Medicine Residency
Program

• E. Gordon DePuey, M.D.
• Director of Nuclear Medicine
• Clinical Professor of Radiology
• Mt. Sinai St. Lukes and Roosevelt Hospitals
• New York, NY

2
Identification of Problems with Current 3-Year
Nuclear Medicine Residencies

• Graduates of NM residency programs have very
  limited job prospects.
• Most practices desire NM physicians who also can
  cover Radiology.
• Interpretation of SPECT or PET with diagnostic CT
  requires Radiology certification
• The quality of NM residency applicants is
  generally mediocre and far inferior to that of
  Radiology resident applicants

3
SLR NM GraduateResident Careers 2009-2014

2009 Entered and completed IM residency after NM residency Now practicing IM
2010 Completed PET fellowship Worked for Medical Education Company Now practicing NM part-time
2010 Completed PET fellowship Entered and completed Radiology residency Now practicing Radiology
2011 Did not pass ABNM Entered and completed IM residency after NM residency Now practicing IM
2013 Entered Molecular Imaging fellowship, passed ABMN
2014 Applying for PET fellowship
4
Support for a 4-Year Combined Program on All
Fronts at SLRHC

• Dr. Gordon DePuey, Director of NM NM residents
  need Radiology training to be marketable.
• Dr. Michael Abiri, Chairman of Radiology
  Eligibility for the ABNM after 4 years of
  Radiology residency will make our Radiology
  program more attractive and competitive.
  However, we cannot fund a 5th year of training
  from the Radiology Private Practice..
• Dr. Nolan Kagetsu, Radiology Residency Program
  Director We must offer the combined program to
  residents with not only the desire but also the
  capability and stamina.
• Dr. Ethan Fried, Chairman GME Committee By not
  adding a 5th year of training we can fund the
  combined program through existing NY State
  financing.

5
Balancing the Program Slots

• As they are vacated, 3-year NM slots will be
  given (loaned) to Radiology. We always have to
  option of recruiting a 3-year NM resident since
  that ACGME-approved program is still open.
• In 2013 Radiology increased their total number of
  slots by 1 (Internal Medicine lost 1 slot).
• Combined DR/NM residents will be recruited as
  such slots become available

6
Regulatory Considerations

• To be eligible for the ABNM exam, the resident
  must document 32 months of DR training in
  addition to 16 months of NM training. ABR
  certification is not necessary to be eligible for
  the ABNM.
• We cannot have a combined NM/DR residency without
  a 3-year ABNM-accredited NM residency. Therefore,
  our ABNM-accredited 3-year NM residency must
  remain in place.
• If a resident completes a 4-year DR residency,
  he/she needs only 1 year of NM training (as per
  the old Nuclear Radiology 1-year residency
  program, which was previously in place at SLRHC).
• NM and DR programs will still be evaluated
  individually by their respective ACGME RRCs.
• Since the 4-year combined NM/DR program is not
  officially ACGME-accredited, it would not
  participate in ADS or any other ACGME survey/site
  visit/review.

7
Regulatory Considerations, contd 2

• The ABNM allows residents to take the ABNM
  examination the fall following completion of the
  combined 4-year DR/NM program.
• The ABNM required one block of NM training in the
  combined 4-year DR/NM program be at least 6
  months long (this requirement is now waived).
• February 2012 issue of RRC New Nuclear Medicine
  The educational plan for combined educational
  programs is approved by the specialty board of
  each of the specialties to ensure that resident
  physicians completing combined education are
  eligible for board certification in each of the
  component specialties. Each specialty of
  subspecialty program is separately accredited by
  the ACGME through its respective Review
  Committee. The combined program is not accredited
  by the ACGME. The duration of combined education
  is longer than any one of its component specialty
  programs standing alone, and shorter than all of
  its component specialty programs together.

8
Regulatory Considerations, contd 3

• In 12/12 the ABR approved conditions and
  requirements for a new pathway leading to
  Diagnostic Radiology primary certification and
  Nuclear Radiology subspecialty certification.
  Residents must complete 16 months of Nuclear
  Medicine within a 48-month Radiology residency.
  Ten of the months of NM must be consecutive to
  preserve the clinical learning experience of
  traditional fellowship pathways. The sponsoring
  Diagnostic Radiology residency program must be in
  an institution with an accredited Nuclear
  Radiology fellowship or ACGME-accredited Nuclear
  Medicine residency.
• Confirmed in December 2012 with Dr. Henry Royal
  (ABNM) and an ABR representative that the
  proposed 4-year combined NM/DR program at SLRHC
  is acceptable for eligibility for both Boards.

9
Implementation at SLRHC

• We have had two 3-year NM resident slots at
  SLRHC. One graduated on 6/30/14, and the other
  will graduate on 6/30/15. Recruiting additional
  3-year NM residents is on hold. Our Nuclear
  Medicine residency program, however, remains
  active.
• In April 2013 two second-year SLRHC Radiology
  residents were accepted into the 4-year combined
  DR/NM program and began 7/1/14. Two additional
  second year SLRHC Radiology residents enrolled
  in April 2014 and will begin NM in 7/1/15.
• On 7/1/15 we will have no 3-year NM residents and
  4 Combined DR/NM residents, two of whom will be
  4th year and 2 of whom will be 3rd year.
• The combined residents will spend 16 weeks in NM.
  During their 4th year they will spend a
  consecutive 6-month block in NM. This will
  satisfy the ABNM requirement for Nuclear Medicine
  Board eligibility, but will not satisfy the ABR
  requirement for Nuclear Radiology Board
  eligibility.

10
Details, Details, Details

• Weekly basic science lectures (1.5- year
  curriculum) will continue to be held. Combined
  DR/NM residents will be excused from Diagnostic
  Radiology responsibilities (except for call and
  night float) to attend. This has required
  considerable juggling of the lecture schedule.
• NM on-call is required, with the combined DR/NM
  on-call every other week during NM rotations. The
  residents are allowed to take certain call
  responsibilities during 16 months of NM rotation,
  such as evening shift and night float, with an
  assurance that there are no duty hour violations.
• A highly successful external Pediatric NM
  rotation (two blocks, two weeks each) shall be
  maintained for combined DR/NM residents.
• In the 3-year NM program we had separate General
  NM and PET/CT rotations for the NM residents. A
  combined rotation for DR/NM residents at the
  Roosevelt site now encompasses both.
• Residents may take 4 weeks of their total
  available vacation days during their NM
  rotations.