Combined Mt. Sinai St. Luke’s-Roosevelt 4-year Diagnostic Radiology/Nuclear Medicine Residency Program E. Gordon DePuey, M.D. Director of Nuclear Medicine Clinical Professor of Radiology Mt. Sinai St. Luke’s and Roosevelt Hospitals New York, NY

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

SLR NM Graduate Resident Careers 2009-2014 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 Entered and completed Radiology residency Now practicing Radiology 2011 Did not pass ABNM 2013 Entered Molecular Imaging fellowship, passed ABMN 2014 Applying for PET fellowship

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.”

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

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.

Regulatory Considerations, cont’d 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.”

Regulatory Considerations, cont’d 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.

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.

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.