The challenges of radiology resident training in Latin America: What are the root causes? how we can help?

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "335" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "F.R. Gutiérrez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "F.R." "apellidos" => "Gutiérrez" "email" => array:1 [ 0 => "gutierrezf@mir.wustl.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Profesor de Radiología, Sección cardiotorácica, Instituto Mallinckrodt de Radiología, San Luis, Misuri, USA" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los desafíos de la formación de residentes de radiología en América Latina ¿Cuáles son las causas subyacentes? ¿Cómo podemos ayudar?" ] ] "textoCompleto" => "I first met Dr. Luis Humberto Ros recent imaging congress in Mexico City, and he was kind enough to offer me the unique opportunity to write an Editorial article on any topic I wanted for Radiologia, the journal of SERAM. As I thought about it, there were several topics that I considered worthy of such editorial, but the one that I thought was most fascinating and timely, was the topic of helping developing countries in Latin America establish quality Radiology residency programs that can meet the needs of their growing population. I am indeed honored and truly indebted to Luis Humberto for giving me the opportunity to render my experience and opinion on this matter, and perhaps awaken the interest of other Spanish speaking radiologists to understand the problems at hand, and perhaps lend a helping hand in this noble endeavor.We have witnessed tremendous technological advances in the field of Radiology in the past decades which have transformed the way the specialty is practiced in order to improve medical care and thus provide better, more efficient service to our patients in a more timely and efficient fashion. It is a well known fact that at the present time our specialty has become the centerpiece of patient care, whether utilized in oncology, cardiovascular medicine, trauma, infectious diseases, among others. Since I finished my residency and fellowship training 40 years ago, there has been a dramatic transformation of how we practice the specialty, and how it has required constant updating of the tools that are at our disposal to diagnose disease entities; whether is new state-of-the-art imaging equipment, radiology information systems or picture archiving and communications systems (PACS). As a consequence, to provide and enhance such high technological services, the costs associated with their adoption and proper integration have increased dramatically and the training in their usage has become more complex and time consuming.I have personally dedicated a great portion of my academic career to visit developing countries and have actively participated in assisting radiology programs in those countries enhance their skillset and fund of knowledge in the area of cardiothoracic imaging. On this editorial, I will discuss some my personal experiences, point out the difficulties and challenges encountered along the way, and try to shed some light into possible ways that we can help those countries achieve the common goal of improving the specialty and thus enhance medical care as a whole.As a result of different economic and social conditions that exist within the many countries of Latin America, we find great disparity among radiology residency programs and the quality of the training that they provide their residents. Every country has different particular circumstances within their borders, whether is Panama, Cuba, Peru or Argentina. However there are certain general commonalities that they share, and that we can use as a foundation and starting point for our analysis.Latin American countries are very heterogeneous, and where the training and practice opportunities are very dissimilar depending on the geographical location of the program within each country.As a general rule, in the larger cities of those countries, we usually find high quality programs that offer superb resident training, and are staffed by subspecialty faculty members, many of whom have been trained abroad. These programs compare favorably with similar training programs seen in Europe or North America. However, some of these programs are centered in private practice settings where the diversity of pathology that is seen in public hospitals may be lacking, partly related to the different socioeconomic status of the patients seen in those centers. As a consequence, those residents training in those well-equipped private programs may not be exposed to more complex pathology or severe trauma cases for example, something that is far more common in state hospitals.By contrast, the radiology residency programs based in public, or university hospitals are staffed with fewer (frequently general) radiologists possessing inferior imaging equipment despite the fact that residents get exposed to a richer variety of pathological entities than the higher level programs. Even though sometimes arrangements are made to have these public hospital residents rotate through institutions with more up-to-date high imaging technology, it nonetheless creates a paradox in the quality of education of forming radiologists and the competency skills and conditions of both training scenarios. To aggravate the problem, staff radiologists in public hospitals are almost universally forced to spend a great deal of their working time in a private practice setting (outside the residency location) to supplement their low academic salaries, which is infurther detriment of the quality of the training they provide their residents. This is in contradistinction to, for example in the United States where most residency programs have full-time subspecialty faculty members that can dedicate more of their time and resources to training residents.Most Radiology programs in Latin America are based on a three year curriculum, clearly insufficient in today's standard to adequately train residents in all the current and emerging modalities. The reason for the 3 rather than a more conventional 4 year program appears to be a consequence of lack of economic resources to train residents in a longer curriculum given the Health Ministry limited allocation of funds in most countries.Lack of economic resources combined with remote locations frequently make it very hard for residents of smaller programs to travel to national or international meetings to enhance their education.On the plus side, the increased use of widely available electronic media has provided a very effective tool to enhance that education and thus achieve greater uniformity in the training for residents no matter how remote their location or small their program may be. One method, the so-called “virtual education” utilizes electronic media to connect in real time the educator with listeners located in remote geographical areas. In addition, it allows the learner to take part in a question and answer session at the end of the lecture akin to the traditional classroom method. An example of how this tool can be effectively utilized is the Louisiana State University International Teleconference Program spearheaded by Dr. Carlos Previgliano in Shreveport, Louisiana. It provides the benefits of continuous education with regular conferences given by prestigious Spanish-speaking subspecialty radiologists practicing in the US and other countries of the Americas.Currently, these video-conferences are transmitted via Cisco Webex to 58 Radiology programs in Latin America on a regular monthly basis and are free of charge to the participating institutions in a vast territory that covers from the Rio Grande to Patagonia.Starting about 30 years ago, we at the Mallinckrodt Institute of Radiology in St. Louis, began a tradition of allowing foreign residents to travel to the US (at their or their institutional expense) to visit our medical center for a one or two month international oberservership tailored to those subspecialty areas of their choosing. These rotations are tuition-free (in some cases a small administrative fee that covers lab coats etc. applies). We generally accommodate 10–12 visiting senior residents a year, for rotations that can vary between 1 and 3 months). It has been a popular activity in which the visitors are given the opportunity to learn and to adapt that knowledge in different ways that they feel can be beneficial to their training programs when they return. Many of those residents have developed academic enthusiasm and eventually become teachers of younger generations of radiologists in their native countries. For me, it has been very gratifying when I go back to those countries to visit, and see how those same individuals have become successful and productive radiologists in their academic programs. Unfortunately, this can be a double edge sword, since many of the radiologists who seek subspecialty training in more developed countries, once their training has concluded and given better working conditions, end up staying abroad, thus defeating the original goal of returning to their homeland and make a much needed contribution to their national peers.The other important element that can provide up-to-date education is to have national and regional societies establish deeper relationships for scientific and educational exchange programs. Examples of these are RSNA, American Roentgen Ray Society, European Society of Radiology and SERAM. As an example, and in the case of ARRS, its International Outreach program, and with the help of Dr. Jorge Soto of Boston University, we have been able to develop a professor exchange program with the Argentinian Society of Radiology (SAR) that provides speakers to their annual society meetings in Buenos Aires in those areas of imaging that they determine there is a need. Along similar lines, The Mallinckrodt Institute of Radiology has now, and for many years, provided visiting professors to national meetings of Mexico, Cuba, Peru, Argentina, Panama, Ecuador and Chile among many others. This type of activity has created a very fertile learning and scientific environment with mutual benefits for the parties involved that has resulted in the creation of academic and research opportunities.In summary, and as a consequence of a very complex set of circumstances, these countries have over the years faced arduous Radiology resident training challenges. Nonetheless, us radiologists who work under more favorable circumstances are in a favorable position to play an important role in the noble task of increasing our support to make those less fortunate Radiology programs improve the quality of the training provided. The final product of this cooperative effort will indeed result in an overall improvement of healthcare to millions of people with whom we share a common language and culture." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Gutiérrez FR. Los desafíos de la formación de residentes de radiología en América Latina ¿Cuáles son las causas subyacentes? ¿Cómo podemos ayudar? Radiología. 2020;62:333–335." ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000006200000005/v2_202011090625/S2173510720300379/v2_202011090625/en/main.assets" "Apartado" => array:4 [ "identificador" => "20744" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000006200000005/v2_202011090625/S2173510720300379/v2_202011090625/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510720300379?idApp=UINPBA00004N"]