The Faculty of Radiologists, Royal College of Surgeons in Ireland is the body responsible for provision of postgraduate training in Diagnostic Radiology and Radiation Oncology inIreland. At present, there are 82 Specialist Registrars in Diagnostic Radiology and 13 Specialist Registrars in Radiation Oncology in full time training in their specialties, spread across eleven centres in diagnostic radiology and three in radiation oncology. Both programmes are spread over five years training, with the exam for the Fellowship for the Faculty taken initially in the fourth year. The Primary Fellowship exam, covering elements of basic science relevant to the specialties, is taken at the end of the first year’s training. After satisfactory completion of five years training, having passed the Fellowship exam, candidates are eligible for inclusion on the Specialist Register of the Medical Council of Ireland, and are eligible to apply for permanent consultant posts in their specialty. Nonetheless, most of our trainees pursue further training abroad after completion of training in Ireland, principally the United States, Canada and the UK, but increasingly in other European countries.
Trainees are advised to inform themselves of the timing of all curricular modules in their academic year and must remember that they are responsible for meeting the various assessment and progression requirements throughout the training programme
Please note that communication with SpRs on the training scheme will ordinarily be by email. It is the responsibility of the SpR to provide the Faculty with a current email address where they will receive Faculty emails, and update the Faculty if a new address is being used
Subspecialist Training Curriculum
Structured Training in Clinical Radiology
Prepared by Dr. John Murray, Co-Ordinator of the Radiology Training Scheme
First Edition (2000)
- Basic Principles
- The First Year-Introduction & Curriculum
- The Second, Third and Fourth Years-Introduction & Curriculum
- The Subspecialty Year of Training (Fifth Year)-Introduction & Curriculum
This text was produced in response to the need to formalise the curriculum for Specialist Training in Radiology. The purpose of this text is to define in broad terms the present curriculum in each year of training. This document also lays down the overall structure of trainee assessment during the period of Specialist Training. For the purposes of this document it is assumed that the academic year begins on 1st July and ends on 30th June of the following year.
- The speciality of clinical radiology involves all aspects of medical imaging which provide information about anatomy, function and diseased states, and those aspects of interventional radiology or minimally invasive therapy which fall under the remit of departments of clinical radiology.
- A clinical radiologist requires a good clinical background in order to work in close collaboration with colleagues in other medical disciplines, and should be demonstrably conversant with: the basic sciences relevant to diagnostic and functional imaging; the pathological and functional aspects of disease; current clinical practice as related to clinical radiology;
- the full range of clinical radiology as indicated in this document; the administration, management and medico-legal aspects of radiological practice; and the basic elements of research in clinical radiology.
Outline of Training Programmes in Clinical Radiology
Each trainee in clinical radiology undertakes a programme of structured training over a minimum period of five years in order to achieve a level of competence in all aspects of clinical radiology that will enable him/her to practise as a specialist.
Basic sciences relevant to clinical radiology are taught in the first year. In addition, the trainee is introduced to interpretative reporting, practical procedures and communication skills.
Thereafter, there should be 36 months of structured training to cover interpretative and procedural skills in all the required subspecialties (see Section 4).
A final twelve months of training will be required to allow for: (i) training in one subspecialty for those who wish to declare a special interest or; (ii) a year devoted to a mixture of two or more subspecialties. This twelve months will usually be undertaken in the fifth year, but may be scheduled in a modular fashion during the fourth and fifth years of training. Additional year(s) of subspecialty training may be needed for subspecialists dedicated to a single subspecialty, e.g. neuroradiology or interventional radiology. Separate curricula will be published for such dedicated subspecialty training.
The current examination structure is as detailed below.
- The First FFR examination comprises physics, radiological anatomy and radiological techniques.
- Provided they have passed the First FFR, candidates are eligible to sit the Final FFR, which is an intermediate examination comprising a mixture of all the subspecialties within clinical radiology.
- Trainees entering a radiology training programme are required to have a minimum of two years of appropriate clinical experience. In Ireland this would comprise one year of pre-registration and one year of post-registration clinical experience. Many also have higher medical or surgical qualifications.
- Training for the Irish CCST must take place in departments accredited for training by the Faculty of Radiologists. Training schemes are centred on teaching hospitals and specialist hospitals. All training schemes are visited by the Faculty for the purpose of accreditation, on a five-yearly cycle.
Trainers are expected to:
- have substantial expertise in their subspecialty;
- be accredited by the Faculty of Radiologists for continuing medical education;
- have demonstrated an interest in training;
- have appropriate equipment available;
- have a sufficiently large throughput of cases;
- have appropriate teaching resources.
A period of research is encouraged. Six months of full-time research in any aspect of diagnostic imaging is allowed as part of the five years of accredited training. At the discretion of the Education Committee, up to twelve months of the five years of accredited training may be spent in clinically based research.
Trainees who hold the FFR may apply for a Certificate of Completion of Specialist Training (CCST) on successful completion of each of the five years of accredited structured training.
This document should be read in conjunction with the most up-to-date version of the following documents issued by the Faculty of Radiologists.
- Training accreditation in Clinical Radiology
- Faculty of Radiologists Training Accreditation in Clinical Radiology, Guidelines to assist with Faculty of Radiology visits to Training Schemes
- Regulations pertaining to the training education and examination of candidates for F.F.R.R.C.S. etc. (Blue document).
- The First Examination of the Fellowship (Clinical Radiology).
- The aim of the curriculum is to produce well-trained competent clinical radiologists capable of being appointed as consultants.
- A major component of training in clinical radiology is achieved by the apprenticeship system with the trainee undertaking an increasing number of radiological tasks. Each component of the training scheme should have a clearly defined structure with supervision of the trainee by senior colleagues (trainers). A named consultant will assume overall responsibility for each rotation.
- Each module of training will consist of all the core topics and some of the optional elements. Training programmes will be expected to offer training in a significant proportion of the optional elements. It is recognised that the amount of training in the optional elements will vary from training centre to training centre according to the facilities available. Both core and optional elements will be reviewed from time to time as practice changes and newer techniques are introduced.
- Years of training activity are not synonymous with years of achievement.
- The trainee should at all times be aware of his/her responsibility to the patient including the necessity for informed consent.
- The trainee will be required to develop those basic skills in research methodology, which are necessary to structure and perform research under appropriate guidance. These skills will include the ability to review published articles critically and to perform effective literature searches on a given topic. An appreciation of the effective application of research findings in everyday practice will also be required.
- Standardised logbooks should be used for documenting the degree of experience and skill attained. Logbooks are mandatory for all interventional procedures irrespective of subspecialty. Logbooks are also of use in documenting the “general professional development” of trainees (see Sections 4.4 and 4.5).
- Individual progress will be evaluated by an annual assessment. The Faculty of Radiologists recommends that the overall education co-ordinator and local hospital co-ordinator will jointly oversee these assessments.
The First Year-Introduction & Curriculum
For most trainees the first year of training represents their first opportunity to learn and acquire radiology skills.
At the end of the first year the trainee should:
- feel confident in his/her choice of clinical radiology as a career;
- have mastered the basic sciences of clinical radiology (physics, radiological anatomy and radiological techniques) to the level of the First FFR examination
- be familiar with the concepts and terminology of diagnostic and interventional radiology;
- understand the role and usefulness of the various diagnostic and interventional techniques in all age groups;
- understand the responsibilities of a radiologist to the patient and the need for informed consent;
- be familiar with the various contrast media, drugs (including intravenous sedation) and monitoring used in day to day radiological practice, and be aware of indications, contraindications, doses (adult and paediatric) and the management of reactions and complications;
- be competent in cardiopulmonary resuscitation;
- understand the principles of radiation protection and be familiar with the legal framework for protection against ionising radiation. The trainee should also demonstrate that he/she is capable of safe radiological practice;
- be familiar with safety requirements for radionuclide imaging and imaging with non-ionising radiation (e.g. ultrasound and magnetic resonance);
- have learnt and performed core radiological and radiographic procedures (see Section 3.3);
- have developed, under supervision, core reporting skills (see Section 3.4);
- understand and practise clinical audit.
An introductory course on basic sciences relevant to clinical radiology is held during the first year. The core of knowledge required to pass the First FFR examination has been defined by the FFR (First Examination for the Fellowship, Clinical Radiology)2.
The Faculty of Radiologists recommends 40 hours of formal tuition in physics prior to attempting the First FFR examination. This teaching should be given primarily by medical physicists supplemented by clinical radiologists. Candidates for the First FFR examination will be expected to supplement this tuition by a substantial amount of self-directed learning.
In addition, the candidate is expected to be familiar with basic practical aspects of radiological physics and radiation safety, typically acquired through practical demonstrations held in conjunction with a Department of Medical Physics.
The Faculty of Radiologists requires that trainees receive formal tuition in radiological anatomy prior to attempting the First FFR examination. This teaching should be given by consultant clinical radiologists. Candidates will be expected to supplement this tuition by a substantial amount of self-directed learning.
Knowledge of anatomy is enhanced by supervised reporting of radiographs in conjunction with consultant trainers. It is expected that each trainee will devote at least three hours (one session equivalent) to this aspect each week.
The Faculty of Radiologists requires that trainees receive formal tuition in radiological and radiographic techniques prior to attempting the First FFR examination. This teaching should be given by clinical radiologists and radiographers. Candidates will be expected to supplement this tuition by a substantial amount of self-directed learning.
In addition the candidate is expected to be familiar with the practical aspects of core radiological and radiographic procedures, typically acquired through a formal training programme supervised by recognised instructors.
Clinical Skills – Radiological and Radiographic Techniques and Procedures
In the first year of training the trainee must begin to acquire some of the practical skills that will eventually be required of a consultant clinical radiologist.
The techniques and procedures listed as core topics in Sections 3.3.1-3.3.11 will have been performed by the trainee under the supervision of a recognised instructor. Where options are given, the trainee should observe as many of these options as possible.
In the case of plain film radiography, trainees should become familiar with the radiographic technique even if they do not take the radiographs personally.
The Second, Third and Fourth Years-Introduction & Curriculum
During the second, third and fourth years of training, trainees should receive structured training in all the constituent subspecialties of clinical radiology. The phrase “fourth year of training” is not meant to be taken literally. The fourth and fifth years of training will incorporate twelve months devoted training for one or two subspecialties for those who wish to declare a specific subspecialty interest (or interests). Although this twelve-month period will usually comprise the fifth year of training, it can be distributed in a modular fashion through the fourth and fifth years.
By the end of the fourth year a trainee will usually have had the opportunity to pass the Final FFR examination. This examination provides evidence of competence as a result of broad basic training in clinical radiology, prior to further subspecialty training.
During the first three years of training, individual trainees will have had the opportunity to assess their aptitude for, and interest in, the various subspecialties, so that they are in a position to decide the most appropriate areas on which to focus their training in the fifth year.
The Subspecialty Year of Training (Fifth Year)-Introduction & Curriculum
The fifth year of training, which may be undertaken in a modular fashion during the fourth and fifth years of training (see Section 4), contains elements of choice. Broadly, these are:
- continued training in core subjects to a higher professional level;
- development of one or more subspecialty interests;
- raining in a single subspecialty, which may continue into a sixth year of training.
It is envisaged that for subspecialty rotations there will be a minimum commitment of six sessions per week to the subspecialty. It will sometimes be appropriate to link system-based expertise with a technique-based expertise. Whether or not it is possible or advisable for this subspecialty training to be undertaken in the base training centre, elsewhere in Ireland, or abroad, should be decided on the basis of: (a) previous assessment of progress and aspirations; (b) local availability and suitability of specialist rotations; and (c) the necessary agreements (see Sections 5.6.1 and 5.6.2).
5.2 The elements of general professional development, as outlined in Section 4.4, will also be pursued during the fifth year of training.
5.3 Annual assessments will continue during the subspecialty year with an emphasis on guidance as to future career choices. Completed log books will continue to be essential in documenting the progress of the trainee towards the completion of her/his training, and the award of a CCST.
5.4 The curricula for selected subspecialties are provided in this document. In general terms the trainees are expected to acquire the elements identified below.
- Detailed knowledge of current theoretical and practical developments in their chosen subspecialty (or subspecialties).
- Extensive directly observed, or unobserved but supervised, practical experience in their chosen subspecialty (or subspecialties).
- Development of clinical knowledge relevant to their chosen subspecialty (or subspecialties). This could take the form of attending clinics/ward rounds.
- Full utilisation of study allowance (currently equivalent to two sessions per week, 1 session research, 1 session meetings/teaching) to pursue research projects within their chosen subspecialty (or subspecialties) and to strive to see this work through to publication. Trainees should be assiduous in attending and presenting such work at appropriate meetings.
- Understanding of clinical audit, and its application to their chosen subspecialty (or subspecialties).
- Documentation of the extent of all relevant training and experience in log books.
5.5 Where the desired subspecialty training cannot be provided on-site, the Faculty recommends that training schemes should make every effort to assist the trainee to obtain an attachment or fellowship at another institution if this is appropriate to his/her career needs. Other forms of attachment, such as a day- or week-release, may provide a suitable alternative for some trainees.
5.6 Training centres must identify a named trainer responsible for each subspecialty in which training is offered.
5.6.1 Trainers should assess the trainee’s aptitude for his/her chosen subspecialty at the earliest opportunity. The trainer, together with the College Tutor and Head of Training should advise those trainees unlikely to succeed within that particular subspecialty as soon as this becomes apparent. Trainees are advised to discuss their chosen subspecialty (or subspecialties) with suitable mentors before embarking on such training.
5.6.2 Apart from the annual review, informal continuing assessment of the trainee by the trainer will be required in order to focus the development of radiological skills.
The curriculum for Subspecialty Training includes:
- Breast Imaging
- Interventional Radiology
Rules and Regulations of Specialist Training
All training will take place in departments fully accredited by the Faculty of Radiologists RCSI and reviewed in the regular Faculty assessment and visits process.
Rotation for specific experience to another accredited training department will be required if the training department is unable to provide the full range of clinical experience
SpRs entering the specialty will have at least three years of satisfactory clinical experience, in this case normally comprising as a minimum the pre-registration year and two other full years of satisfactory General Professional Training (GPT).
The attainment of an MRCPI or other equivalent higher qualification is not required for eligibility. However additional qualifications by applicants will be viewed favourably during the SpR interview process.
The period of training is for five years of certified specialist professional training. Candidates will be appointed to the training programme for a period of 5 years, provided attendance, work ethic, and general conduct is deemed satisfactory by the Medical / Clinical Director and the Hospital Training Co-ordinators (HTC) of their accredited training departments.
SpRs will maintain a record unique to their training in specifically designed “logbooks” which will be paper based for the present, but will eventually be web based. SpRs will undergo annual assessments, undertaken by their trainers and recorded in a report. This report and the “logbook” will provide a detailed record of the knowledge and experience gained during each year of training.
Training will need to evolve to allow for the statutory introduction of the 58-hour week introduced in 2004 and the change to a 48-hour working week in 2009, as per EU directive.
Flexible Post (Part Time) Training
All periods of time specified are full time equivalent. Flexible (part time) may be undertaken by SpRs. Flexible SpRs will require more than the minimum 5 years training to be eligible for entry on to the Specialist Register. The time required will be assessed on a “pro-rata” basis and according to the acquisition of clinical skills recorded in their training “logbook”. They will be subject to annual assessments similar to the fulltime SpRs.
Fixed Term Training Appointment (FTTA)
A registrar can be appointed to a Fixed Term Training Post, (for a maximum of 1 year), if an SpR already “in post” elects to apply for leave from a clinical post to undertake 1 year’s research, a 1 year Out Of Programme Experience (OOPE), or family leave. This position is appointed by open competition following interview by the Faculty officers and training co-ordinators. This period, to a maximum of 1 year, will be recognised if the candidate is subsequently selected for an accredited SpR training programme.
Resignation from SpR training programme
An SpR wishing to resign from the programme will have to serve 1 month’s notice in writing to the National Training Co-ordinator (NTC), their Hospital Training Co-ordinator (HTC) and their hospital’s HR department.