How to create a successful breast imaging fellowship

In 2013, the American College of Radiology and Society of Breast Imaging created standardized curriculum for U.S. breast imaging fellowships. However structural and organizational guidance for these fellowships is in need of improvement, according to an article published Aug. 14 in the Journal of the American College of Radiology.  

Although breast imaging fellows learn the most from their own clinical work, successful fellowships should embrace a structured developmental framework rich in opportunity, support and feedback, the authors wrote.  

This framework should provide fellows with experiences in teaching, scholarly work, journal clubs, multidisciplinary conferences, quality assurance work and opportunities to receive constructive feedback on a regular basis, wrote lead author Jordana Phillips, MD, a breast imaging instructor at Beth Israel Deaconess Medical Center in Boston, and colleagues.  

“Rather than being viewed as the final stage of residency, breast imaging fellowship is the first step toward a career filled with community, inspiration and leadership,” Phillips et al. wrote.  

Specifically, a successful breast imaging fellowship should provide a developmental framework using the Dreyfus model of skill acquisition and expectations of the program should evolve over the year, according to the authors.

To address the inequity of fellows beginning training with different levels of experience in the field, the authors explained that fellowship directors can structure the program into four-stages paralleling to the four quarters of the fellowship year:  

  • First quarter: Introduce fellows to members of the team, breast imaging systems and the basics of how to interpret and report all breast imaging exams.  
  • Second quarter: Fellows apply what they’ve learned and gain competency in basic diagnostic cases and procedures.  
  • Third quarter: Period of “supervised independence” when fellows can now perform basic breast imaging and take on more challenging cases with faculty support.  
  • Fourth quarter: Fellows are “mini-attending physicians” while receiving continued support and supervision, allowing them to practice independently and safely.  

Fellows should also be given opportunities to be exposed to all aspects of breast imaging, which includes all imaging modalities (screening mammography, diagnostic mammography and ultrasound, breast MRI, etc.), practices types, quality control with technologists and the various aspects of breast cancer care. Participation in multidisciplinary conferences and scholarly projects should also be a necessary component of any breast imaging fellowship, according to the authors.  

“Participation in multidisciplinary conferences provides context for breast cancer care so fellows may generate clinically meaningful reports and play a larger role in the treatment team,” the authors wrote. “Participating in a scholarly project allows fellows to learn about the research process and is an opportunity for them to give back to the larger radiology community.”  

As more breast imaging fellows identify as millennials, the authors explained that fellowship directors should look for education resources that are shorter, interactive and more engaging to better suit their fellows' current learning styles.  

“Introducing fellows to the larger passionate community of breast imagers involved in clinical care, education, research, outreach, administration, leadership and advocacy should also be facilitated,” the authors wrote. “Engaging fellows early helps build a sense of community and belonging. This is increasingly important to counter burnout, because rates are on the rise, and to inspire a new group of leaders.”