Choosing a Career in Graduate Medical Education

“Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.”

-Robert Frost

I was not aware of it at the moment, but my career-defining fork in the road came in 1988 as a fourth-year medical student at Northwestern University in Chicago. I envisioned a future as a clinical neurologist but wanted to do an elective close to home in Massachusetts and chose diagnostic radiology at St. Vincent Hospital in Worcester. Little did I know that this was the beginning of a journey that would lead me back to St. Vincent and a career dedicated to radiology and graduate medical education.

The road began at the “old” St. Vincent Hospital on Vernon Hill. The facility was a large 1960s-style imposing structure with few recent updates. It was before the age of digital imaging, voice recognition dictation, and high-resolution multi-monitor PACS systems. There were alternators (multi-panel light boxes) loaded with films for interpretation, and reports were typed by transcriptionists with carbon copies for distribution. In short, the hospital and resources were quite ordinary, but everything else was extraordinary.

Walking into the department on my first day, I sensed an energy emanating from the large central reading room. Congregated around the alternators were residents and teaching attendings actively engaged in discussing and debating findings on imaging studies of all types - CT, MRI, ultrasound, nuclear medicine, radiographs, and more. It was a beehive of activity with every study presenting anatomic or metabolic patient care puzzles for the team to solve. At the center of it all was my mentor, Dr. Murray Janower.

Dr. Janower was Chief of Radiology at St. Vincent Hospital and founder of the radiology residency program in 1972. Unbeknownst to me at the time, Dr. Janower was a renowned radiologist and recognized national leader in graduate medical education. One of his most impactful publications was on the design of radiology departments, a model that he implemented at St. Vincent Hospital. Based on “form follows function” he created a structure that fostered the educational environment in which resident training flourished, physicians collaborated, and patients benefited. Before the end of my fourweek elective rotation, I knew that I wanted to be a radiologist and be part of a teaching program.

I was fortunate to match for my one-year medical internship and four-year radiology residency at St. Vincent Hospital and returned a year later to begin my training. It was a challenging and rewarding radiology residency with a talented faculty team led by Dr. Janower. My training reinforced my desire to be in academics, ideally at St. Vincent Hospital. Following residency, I pursued a nuclear medicine fellowship at the Harvard Joint Program in Boston. I did not hesitate when a position became available to return to St. Vincent Hospital in April 1997 and I am still there today.

I was immediately immersed in the teaching program as faculty for diagnostic radiology and nuclear medicine and, shortly thereafter, was appointed to the role of Associate Residency Program Director where I trained under the tutelage of Dr. Janower for three years before his retirement. This was my introduction to another facet of graduate medical education, leadership responsibility for oversight of the larger systems and infrastructure of a teaching program. I then transitioned to Program Director and subsequently the Chief of Radiology. In addition, I was the Designated Institutional Official for three years at St. Vincent Hospital, responsible for oversight

of all ACGME (Accreditation Council for Graduate Medical Education) teaching programs. All these experiences provided tremendous growth and learning opportunities. For me, it was a natural evolution to not only teach but to be dedicated to creating, maintaining, and advancing a robust environment for residents and teaching faculty to thrive.

I found (and still do today) that I learn as much or more from my residents than I teach them. Teaching makes me a better physician, constantly challenged to stay ahead of the curve of rapidly evolving fields. However, the increasing throughput demands of clinical care and lack of financial and physical resources often hinder a physician’s ability and desire to be in an academic setting in any role.

Another challenge is that the sphere of control for a physician gets smaller the farther one moves from the role of directing clinical decisions for patient care, which is what we are trained to do. Teaching and leadership training are not normally part of medical school curricula and require a different set of skills and expectations. Making a clinical assessment and a patient management decision is more controlled and immediately impactful rather than navigating the complex systems of healthcare and accrediting organizations. Most physicians understandably complain about system issues and inefficiencies, yet few engage in effecting change. Choosing a role in teaching is a challenging but impactful way to be the change needed by setting standards of care and leading by example.

The practice of radiology and graduate medical education are inextricably linked for me, I cannot imagine working in an environment not fueled by the energy of a residency program. I do not view the challenges of teaching and leadership as a distraction from my role as a physician dedicated to patient care, but rather as integral to it. I have had the privilege of playing a role in twenty-eight classes of radiology residents, during which time there have been truly transformational changes in healthcare delivery and stunning technological advances in radiology and nuclear medicine.

The one constant has been the residents. Their intellectual curiosity, passion, commitment, and dedication are aspirational. The graduate medical education path may be one less chosen, but it can be incredibly rewarding. Teaching is a virtuous cycle, an opportunity to pay it forward one resident and, most importantly, one patient at a time. That can make all the difference.

David A. Bader MD, FACRPresident Saint Vincent Radiological Associates, Inc.Chief of Radiology, Radiology Residency Program Director, St. Vincent Hospital, Worcester, MAChief of Radiology, MetroWest Medical Center, Framingham, MA

david.bader@stvincenthospital.com 508-363-6060