USC/LA General Radiology Residency Program

Weekend/holiday daytime hours for County inpatient and emergency radiology are covered by the junior resident classes for 18 months beginning in January (i.e. from January 1 of the R1 year, to June 30 of the R2 year). Hours are 8AM – 4PM.

The R1 class is call-free for the first 6-months of residency. Beginning January 1, the R1 class covers the emergency department weekend day shifts, where they have direct faculty supervision. This duty averages to ~2 shifts per month.

From July to December 31, R2’s work a separate inpatient/procedure shift from 8AM to 12PM, under direct faculty supervision. After 12PM, preliminary reads are placed by R2s for requested inpatient studies, with an attending available remotely for support. On January 1 the R2 residents “graduate” from emergency department daytime coverage, but continue to cover inpatient/procedures until June 30.

Weekend/holiday daytime hours for Keck and Norris are collectively covered by R2’s (after January 1), R3’s, and R4’s. This approximates to roughly 3-5 shifts/year for senior residents, and 2 shifts for R2’s in the late academic year. Hours are 8AM – 5 PM. A portion of this shift is directly supervised by faculty.

Overnight Coverage for LAC, Keck, and Norris inpatients is provided mostly by R3 and R4 residents. Hours are 10PM–8AM for weekdays and 8PM–8AM on weekends/holidays. This averages to 2.5 weeks per year. This shift simulates independent call, but attending available remotely for support.

R2 and R3 residents on Interventional Radiology rotation carry a service pager in order to provide 24-hour coverage for LA County and Keck Hospital, in selected cases. Two to three residents are typically on service at a time. This varies from 12–18 shifts per year, depending on the number of residents on service.

R3’s are scheduled for a call-free period preceding the Core Exam in order to aid in exam preparation.

Robert D. Harris, MD, MPH, has been an academic radiologist for 34 years at several institutions, most recently at USC since 2019. He is very interested in global radiology and ultrasound, the latter lending itself to low resource settings, especially. He has done global medical work in Haiti, Serbia, Vietnam, West Africa, and more recently, East Africa, where he spent the year 2015-16 and part of 2017 working for the grant Human Resources for Health, educating radiologists in Rwanda to train upcoming radiologists in that country, and teaching physicians about basic imaging principles and techniques.

At USC Keck, he is the director of the revitalized USC RAD-AID chapter and has helped to fashion a remote teaching program with the Tanzanian radiology residency at Kilimanjaro Christian Medical Center in Arusha, TZ. Weekly lectures are being given by USC faculty and fellows/residents and are well received by the 7 new residents in Tanzania. The goal is to start in-country teaching/visits in 2022, but this, of course, is reliant on COVID-19 travel restrictions. Other members of the department (neuroradiology, specifically) are reading remote CT scans from Port au Prince, Haiti, providing a vital service to the patients there.

Hospital Bernard Mevs in Port Au Prince is the only tertiary care hospital in Haiti, with a CT scanner and trained CT technologists. At our institution, we partnered USC neuroradiology fellows with USC attending neuroradiologists to interpret neurologic and body CT scans at this hospital in Haiti. Interpretation of CT scans occurs through a web-based PACS set up by a non-profit organization. The fellows draft reports for neurologic and occasionally body CT examinations, which are then edited by the attending neuroradiologists at our institution. The reports are uploaded, with critical findings discussed with the clinical teams.

Comments from past participating fellows:

“This was an excellent experience to understand how the availability of resources affects care, in both good and bad ways. I also found it to be a rewarding experience that was eye-opening as to how severe limitations can be.”

“The exercise provides opportunities to understand the operational aspects of teleradiology in a rural setting. Cases show unique pathologies not commonly seen in urban settings. Follow-up strategies have to be tailored to work around limitations in healthcare system resources.”

“Informative, meaningful, with a wide range of cases.”

The final year of residency is divided into 4 blocks.  Each resident will complete two required blocks, one in general radiology, structured as a transition to practice rotation that will include all imaging modalities in body imaging; and one that will include one month each of nuclear medicine, neuroradiology, and mammography in order to meet ACGME requirements.  The other two blocks will be elective “mini-fellowships” in two areas of specific interest to each resident.

This department has an ACGME accredited training program in Nuclear Medicine.  Because of this, it is possible for graduates of the Diagnostic Radiology residency program to qualify for the American Board of Nuclear Medicine certifying examination.  Selected residents (up to 2 per year), can structure their residency to meet this qualification and have the opportunity to be double boarded.

The County of Los Angeles provides very limited opportunities for an international educational experience during residency.  These include:

• Elective with credit towards residency must be approved by the program director; must have Goals and Objectives with a qualified supervising faculty at the receiving institution; must be at an institution with an Affiliation Agreement with the County of Los Angeles that will reimburse resident salary and benefits; must be approved by the RRC of ACGME and the ABR
• Elective without credit towards residency may be taken during vacation time or during an unpaid leave of absence
• Note that the American College of Radiology does sponsor the Goldberg-Reeder Resident Travel Grant program which is a potential source of funding for international elective  (http://bit.ly/ACRFGRG)

Graduated call responsibilities are fully implemented in compliance with ACGME requirements. Beginning on Dec 31 of the PGY2 year, residents take in house evening call Monday –Friday and day time in house call Saturday and Sunday – with direct faculty supervision. Overnight call responsibilities begin later in residency and continue through the PGY5 year. Primary responsibility of the overnight call is to review and report on Emergency Department imaging studies. Pager call exists in the PGY3-5 years for specific services, including Interventional Radiology. Residents have no call responsibilities during the three months prior to the ABR Core Exam. Faculty backup exists for all call duties. According to current ACGME resident survey data, this program has no violations of duty hour requirements.

Formative evaluations of resident performance are submitted by faculty at completion of each clinical rotation, The program’s Clinical Competency Committee reviews resident Milestone status semi-annually, and advises the program director regarding resident progress, including promotion.

Objective measures of resident performance in comparison with national performance include the ACR In-Training examination (PGY2, PGY3, PGY4, PGY5), the ABR Core examination (PGY4), and the ABR Certifying Examination (15 months after completion of residency. Current programmatic pass rate for the Core Exam is 97% and for the Certifying Exam is 100%.

Most USC radiology residents go on to do subspecialty fellowships. Our residents have been very successful in being accepted to fellowship positions of their choice at excellent institutions including USC, UCLA, UCSD, Stanford, UCSF, Oregon Health Sciences University, University of Washington, Emory, Massachusetts General Hospital, and Yale. Graduates most frequently choose a private practice career path, with many remaining in Southern California where an extensive network of USC Radiology graduates exists. However, several recent graduates opting for academic careers have obtained positions at a variety of institutions, including USC, UCSF, Cornell, Memorial Sloan-Kettering Cancer Center, University of Washington, and University of Pennsylvania.

The 600-bed medical center is one of the largest public hospitals in the country and recently relocated to a brand new facility on the medical campus in 2008. USC’s relationship with the County Hospital dates back to 1885. The hospital is an extremely busy Level-One Trauma Center and the hub of the County wide healthcare system serving 10 million residents of Los Angeles County with a mission to provide accessible, affordable, and culturally sensitive healthcare to the poor and underserved. Residents spend the majority of their time in their PGY-II to PGY-IV years at the Los Angeles General Medical Center. The hospital houses three 1.5T magnets, four CT scanners and 16 ultrasound units. Three angiography suites and three fluoroscopy suites are available for interventional and GI procedures.

The 401 bed hospital is a tertiary and quaternary referral center for Central and Southern California. A total of 18 clinical departments provide specialized patient care and direct clinical studies and trials. The Radiology department houses 2 CT scanners, 3 fluoroscopy suites, 3 angiography suites, 5 ultrasound units, one 1.5T magnet and two 3T magnets. Next door to the Keck Hospital, HCC1 and HCC2 serve as two outpatient centers housing the PET center and an outpatient radiology site respectively. Residents rotate through Keck Hospital in their PGY-II and PGY-III years and again in their PGY-V year on the Neuroradiology, Musculoskeletal Radiology, and Body Imaging mini-fellowships.

One of the original eight National Cancer Institute designated comprehensive cancer centers in the United States, Norris was established in 1973. Residents spend a dedicated 4-week rotation in their PGY-IV year focused on Oncologic Imaging. Rotating through Norris exposes residents to pathology seen only at a dedicated cancer center. In their PGY-V year, residents may spend additional time at Norris on several of the mini-fellowships. In particular, the Norris Breast Center provides comprehensive breast imaging and intervention training, including tomography, for residents on the Women’s Imaging mini-fellowship. Two CT scanners, 2 ultrasound units, 2 fluoroscopy suites and an angiography suite are housed at Norris with plans to install a third CT scanner.

Residents will be provided Life Insurance, Health Insurance, Dental Insurance, Workers’ Compensation, Jury Duty Leave, Sick Leave, Bereavement Leave, Witness Leave, Military Leave, and Civil Service Examination Leave at the level agreed to by the County and the Coalition of County Employee Unions in the Memorandum of Understanding entered into on December 16, 2003 regarding the Fringe Benefits. Via the CIR, residents pay a yearly amount into a fund for disability insurance and may purchase additional outside disability insurance.

Residents receive 24 paid leave days per academic year. These vacations must be approved by the program coordinator and prescheduled. At the time of residency completion, unused vacation time may be paid out at a standard rate. Residents receive 8 sick days per year, up to 5 of which may be used as personal days. Unused sick days may be paid out at six-month intervals per LA County policy and procedure. NOTE: The American Board of Radiology allows a maximum of 30 days per year away from training to maintain eligibility for graduation. Taking over 30 days per year in vacation/sick/personal days may result in extension of residency beyond the expected date of graduation.

Residents are provided with a daily stipend for meals that totals $25 per day. Each meal has a set price limit.

Free proximity parking is provided to residents at both the Los Angeles General Medical Center and Keck Hospital of USC.

The County of Los Angeles provides residents with white lab coats and scrubs. Each resident is also provided with a pager; a name badge with electronic access pass to the facilities; access to and training on HIS, EMR, PACS, and dictation systems; and radiation dosimetry badges.

The County of Los Angeles pays for the testing fee for each Diagnostic Radiology resident to take the California radiography/fluoroscopy licensing examination.

The Department of Radiology provides each resident with tuition to attend the four-week AIRP Radiologic-Pathologic Correlation course as well as a cost of living stipend of $1000. Residents receive a total stipend of $800 over the residency to attend up to 2 review courses.. The department also provides each resident with tuition for a physics review course which includes on-line modules, a textbook, and a live review course during the R3 year.

The Department of Radiology provides residents with financially supported academic time to present educational exhibits and scientific abstracts at local/regional/national medical meetings. Details of this support are outlined in a departmental policy available on the intranet.

The Department of Radiology provides each entering resident with a comprehensive radiology text. The department owns a library of subspecialty texts that may be checked out by residents. The department also subscribes to online radiology educational materials including StatDx and RadPrimer. All residents have physical access to the Norris Medical Library on campus, as well as its on-line database materials.