How to Apply: Fellowships in Musculoskeletal Imaging
Please Note: Positions for the 2013 Musculoskeletal Imaging Fellowship program have been filled. We are currently accepting applications for 2014.
How to Apply
The timeline for the Fellowship Year beginning July 1, 2014 will be:
- Applications accepted now
- Interviews will take place late September to early November or until filled
- Offers to external candidates will be made on a rolling basis
To apply, visit the
Job@UVA and search on posting numbers 609644 and 609568. Complete a
candidate profile online and attach a curriculum vitae (CV) and cover
letter; the cover letter will serve as your personal statement. Also
include a copy of your USMLE scores in writing sample 1 and your ECFMG
certification in writing sample 2 if applicable. Candidates must have
an MD or equivalent and be ACGME accredited Diagnostic Radiology
International medical graduates are welcome to apply to our fellowships. Fellows are selected on the basis of their medical training, general and academic achievements, and personal qualities. No preference is given to any particular medical school or geographic area, nor is race, sex, or national origin a consideration. International medical graduates need to have a permanently validated ECFMG certificate and have passed USMLE Step 3. They will be offered a visa for the duration of their fellowship.
Please have your references submit three current letters of recommendation directly to:
[For US Postal service delivery]
University of Virginia
Department of Radiology and Medical Imaging
Charlottesville, VA 22908
[Physical address for all other forms of delivery]
University of Virginia
Department of Radiology and Medical Imaging
1215 Lee St
Charlottesville, VA 22908
Program Overview and Goals
During the training, we expect fellows to:
- Provide excellent patient care and timely service to our referring clinicians
- Foster a service-oriented atmosphere in our reading rooms as well as in our personal interactions with referring clinicians, imaging technologists, and radiology colleagues
- Provide efficient image interpretation such that we add value to the patient’s workup
- Learn from each other and remember that we’re all teachers as we interact with residents, medical students, and clinicians on a daily basis
Upon completion of the Musculoskeletal Imaging Fellowship Program, fellows will:
- Have seen enough cases that they feel comfortable interpreting radiographs, CT, and MRI studies involving the musculoskeletal system, and also feel competent to perform basic musculoskeletal ultrasound examinations
- Be comfortable performing a wide range of image-guided musculoskeletal procedures, including arthrography, discography, bone and soft tissue biopsies, radiofrequency ablations, and a variety of pain control injections
- Confidently operate independently in all areas of our practice, including the interpretation of emergency radiology studies, having been given graded responsibilities as the year progressed
- Compose and deliver one didactic lecture and one case conference to the members of the MSK Division and Radiology residents
- Complete at least one research project during the year, which includes submission of at least one manuscript for attempted publication; if timing allows, you will have had the opportunity to present your work at a meeting
Our division covers all musculoskeletal imaging studies performed at Hospital East, Fontaine Orthopedic Clinic, UVA Outpatient Imaging Center, UVA Northridge Clinics, and McCue Sports Medicine Center. Fellows will rotate among six tracks, on a weekly basis:
1. Hospital East – Cross sectional studies
2. Hospital East – Radiographs/procedures
3. Fontaine Clinic – Cross sectional studies
4. Fontaine Clinic – Procedures
5. Fontaine Clinic – Plain films
6. “Utility” Rotation – Covering for academic and vacation days
Hospital 1 Rotation: Cross-Sectional
- Consultant for clinicians and radiology colleagues (MSK imaging studies)
- Interpretation of MSK CT/MR studies
- Interpretation of DEXA scans
- Interpretation of plain films (depending on overall volumes)
- When possible, assist with reading out radiographic or cross-sectional imaging studies from Fontaine
- Prepare and present radiology portion of weekly sarcoma conference if Hosp 2 fellow is unavailable to do so
- Consultant: The
fellow assigned to this rotation functions as the primary consultant
for clinicians with questions regarding MSK imaging studies, and
provides early reading interpretations with the resident when the
faculty is not present. The fellow should be present in the reading
room as much as possible and accessible via pager when not physically
in the room. (Name and pager # should be written on the white board
- Cross-Sectional Imaging Studies: The fellow should arrive in the reading room by 7:30 A.M. and organize all cross-sectional MSK studies that have accumulated overnight. Please see the MSK Workflow on PACS document if not accessing an Epic work list. Preview the CT and MRI studies and note your impressions on the request or, preferably, pre-dictate a report into the Powerscribe system. An attending readout will typically occur between 9:00 and 9:30 (the exact time of the initial readout will vary depending on the attending and procedure schedule). Additional readouts will occur during the day. If a faculty member is not scheduled at the hospital in the afternoon, studies can be reviewed with a faculty member at Fontaine via phone and PACS. Study volumes will typically be higher when we are covering trauma spine imaging (even months).
- After the first few months (usually in September or October) all CT studies that are generated during the day are to be interpreted by the resident assigned to the MSK service. Early in the year, the fellow should review the CT with the resident prior to the attending readout. Later in the year the fellow will be performing the final readout of some of these studies with the resident.
- Before leaving for the day, the fellow should check the MSK CT and MR work lists in Epic to see if there are any stray studies that need to be interpreted.
- Overnight Trauma CT Spine Studies: Beginning in August, the fellow will staff out the trauma spine CT studies obtained overnight and interpreted by the on call resident. If the Hospital 2 fellow does not have an early procedure, these should be divided equally between the two fellows.
- Consultant: This fellow is the primary consultant for referring clinicians who frequently come to the reading room to review imaging studies. Except in extreme circumstances, the clinician should receive a, “Hi, can I help you?” within 30 seconds of entering the room. It is important to provide as much help as possible until the clinician’s concerns have been addressed.
- DEXA scans: DEXA scans performed at the hospital will be interpreted by the Cross Sectional Fellow. The paperwork from DEXA scans to be read will be placed in the box behind the reading room door each afternoon. Those reports are to be sent to report queue of the attending assigned to the hospital that day and the paperwork placed in his or her box.
- Plain Films: The fellow should assist with the interpretation and dictation of radiographs in the MSK reading room whenever the cross-sectional and procedure volumes allow.
- Sarcoma Conferences: If the Hospital 2 fellow is not available, the Hospital 1 fellow will review and then present the cases for the weekly Sarcoma Conference, currently held on Tuesday afternoon at 4:30pm. During the early months of the year, a faculty member will accompany the fellow to the conference.
- Assist with Fontaine Studies: Whenever possible, the hospital fellow will help read out radiographs and imaging studies from Fontaine.
Hospital 2 Rotation: Radiographs/Procedures
- Interpret radiographs at the hospital in conjunction with the junior resident on the service
- Organize and perform all image-guided MSK procedures at the hospital
- Organize and present the imaging studies at the weekly Sarcoma Conference, usually held each Tuesday at 4:30 pm
- Assist where needed as determined by the workload and attending physicians on service; this may involve reading studies from Fontaine remotely or, in rare instances, providing coverage on site at Fontaine
- Plain film interpretation: The fellow assigned to this rotation is responsible for the interpretation of radiographs performed at the Hospital in conjunction with the junior resident assigned to the MSK service. The workload will be divided between the resident and fellow in a manner commensurate with their levels of experience.
Please see the MSK Workflow on PACS document if not accessing an Epic work list.
Initially the fellow will sign out all films with an attending but, after the first few months (usually beginning in August or September), the fellow will primarily interpret radiographs on their own. When films are interpreted by the fellow alone, any studies about which the fellow has a question or concern should be showed to the attending during the supervised portion of the readout.
This fellow is also responsible for reviewing “early read” films with the resident during the day. Additionally, beginning in September or October, this fellow will be assigned to staff out the resident for one day during their week on this rotation (all radiographs and CT’s, including the overnight ER films).
- Overnight Trauma CT
Spine Studies: Beginning in August, the trauma spine CT
studies obtained overnight and interpreted by the on call resident will
be divided equally and staffed out by both hospital fellows. If the
Hospital 2 fellow has an early procedure, these will be covered by the
Hospital 1 fellow.
- MSK Procedures: Typical procedures performed at the hospital include CT or fluoroscopically guided bone and soft tissue biopsies, discography, and other percutaneous procedures requiring nursing support (i.e., steroid injection in a patient with an iodine allergy, etc.)
The fellow is responsible for checking with Diane in the reading room or the scheduling office (phone # 3-6888) each afternoon to determine whether there are any procedures scheduled for the following day. If there are, the patient’s imaging studies should be reviewed and the appropriate faculty member notified before leaving for the day. Some procedures may be scheduled at 8:00 in the morning, and as such, the fellow will need to consent the patient and work with the technologist to prepare the needed materials prior to that time. For image-guided biopsies, the fellow will consent the patient and then determine the biopsy approach and necessary needles in conjunction with the attending covering the procedure.
- Helping with Overflow Studies: The utility fellow will assist with reading excess radiographic or cross-sectional imaging studies at Fontaine when possible. In most instances, this will be done remotely via PACS, however there may be occasions during the year when the Utility Fellow will need to cover on site at the Fontaine center.
Fontaine Clinic: MRI/CT Rotation
- Interpret CT and MR examinations performed at Fontaine
- Serve as a back-up consultant to the plain film fellow for clinicians in the reading room
- CT/MRI Interpretation: The fellow should arrive by 8am and preview the MRI and CT studies that have accumulated since the prior day. The fellow is also responsible for giving a portion of the studies to the resident(s) on the service. The number and type of scans given to each should take into account their level of experience. The morning readout will typically begin between 9:30 and 10:00 A.M (or earlier by pre-arrangement between the fellow and attending if there are an excessive number of studies waiting to be read). At least one more readout session should occur between 2:30 and 3:00pm. Please see the MSK Workflow on PACS document if not accessing an Epic work list.
- First thing in the morning, the MRI fellow needs to protocol all cross-sectional studies in the MSK MR and CT protocol list in Epic. The lists should be checked again midday and prior to leaving in the evening.
- Consultant: The fellow assigned to cover cross-sectional imaging studies will also function as a back-up consultant for clinicians should the Plain Film fellow be unavailable.
Fontaine Clinic: Procedures
- Oversee and perform all image guided procedures in the Fontaine Clinic.
- Supervise residents in the performance of basic procedures (later in year).
- Assist with cross-sectional and plain film interpretation when possible.
- Image Guided Procedures: The fellow covering procedures should arrive no later than 8:00 A.M. to review the requests for the patients undergoing procedures that day and to be available should any clinician request an add-on procedure. Most days, procedures will start by 8:30 AM and the fellow is responsible for drawing up the contrast and medications with the imaging technologist in the fluoroscopy room, verbally consenting the patient (the patient will have already filled out a written consent form), and checking for any contraindications to the procedure (a part of the patient’s consent form includes pertinent questions regarding anticoagulants, allergies, etc. Be sure to review this).
A “time out” will also be performed in conjunction with the imaging technologist once the patient has entered the room. This consists of asking the patient to state their full name and birth date, as well as what specific type (and site) of procedure is to be performed.
Initially, a faculty member will perform the procedures while the fellow observes, however, this reverses relatively quickly with the fellow performing an increasing number of the procedures under the attending’s direct guidance. As the year progresses, the fellow will begin to operate on their own, typically beginning with shoulder arthrograms, so that by the end of the year, each fellow should be comfortable working independently. However, it should be emphasized that the fellow should not hesitate to consult the attending at any time for a procedure related question or concern.
After each procedure, the fellow helps to prepare the room (replacing sheets and pillow cases, drawing up contrast and medications, etc.). The technologists will do as much as they can in this regard, but they are also responsible for completing the last study and entering data for the next one. Room preparation is vital to keep the patient flow moving.
- Add-on Procedures: Physicians and nurses in Ortho Clinic frequently request an add-on (non-scheduled) procedure for a patient being seen in the clinic that day. These should be accommodated that same day with few exceptions. If it is felt that a procedure cannot be accommodated, the fellow should discuss this with the attending covering procedures before a final answer is given to the clinician.
Fontaine Clinic: Plain Film Rotation
- Interpret plain film studies at the Fontaine Center
- Interpret DEXA scans performed at the Imaging Center
- Primary consultant for clinicians in the Fontaine Reading Room
- Plain film
interpretation: The fellow assigned to this rotation is
primarily responsible for the interpretation of radiographs performed
at the Fontaine Center. Initially all films will be signed out with an
attending but, after the first few months (usually beginning in August
or September), the fellow will primarily interpret radiographs on their
own. As the year progresses, the fellow will also be assigned to staff
out a resident. Whenever films are interpreted by the fellow alone,
any studies about which the fellow has a question or
concern should be showed to the attending during the supervised portion
of the readout.
- DEXA Scans: The fellow will interpret and dictate all DEXA scans performed at the Fontaine Imaging Center. These should be dictated with the attending assigned to imaging that day, and the paper work placed in their box.
- Consultant: This fellow is the primary consultant for referring clinicians who frequently come to the reading room to review imaging studies. Except in extreme circumstances, the clinician should receive a, “Hi, can I help you?” within 30 seconds of entering the room.
Often, a clinician or one of their nurses will come to the reading room to request an add-on procedure for that day. If the fellow and/or attending covering procedures happens to be in the reading room, the clinician can be referred directly to them, however, if they are busy in the back, the fellow should take all the information, go back and discuss it with the nurse and procedure fellow and then let the clinician know if we are able to accommodate their patient. Be sure to ask whether or not they need insurance preauthorization, whether the patient is on any anticoagulants, or if they are allergic to contrast material.
- To cover the fellow on vacation or assigned to academic time on a given day
- General: Each fellow will be given a pager and will be on call, typically on a weekly basis, in rotation throughout the year. A fair schedule will be determined by Dr. Anderson. Five fellows will be on call over one of the university holidays and the sixth will cover one extra call week in lieu of a holiday. Official holidays include: July 4th, Labor Day, Thanksgiving, Christmas, New Years, and Memorial Day.
- After Hours Requests: When on call, the fellow is responsible for handling all emergent MRI studies obtained during off hours and for consultation regarding any MSK imaging study or interventional procedure.
- For MR studies, there are standard protocols for virtually all types of requests and the senior in-house resident is expected to protocol the study prior to scanning. Residents, however, are encouraged to call the MSK fellow if they have any questions or unusual cases. Any MR examination on a patient being taken to surgery on the basis of the study results must be checked by the fellow on call. The resident will then provide a preliminary interpretation to the ordering clinician.
- The fellow on call is also responsible for dealing with requests
for image-guided procedures during off hours. Early in the year, this
may require consultation with the faculty on call regarding the
appropriateness of the request. Assuming the procedure is approved, the
fellow should check with the referring clinician regarding the
patient’s coagulation status, allergies, etc. The fellow will then
notify the neuroradiology technologist on call (since fluoro guided
procedures are performed in Room 3 in the Neuroradiology Suite at the
hospital) or the CT or US technologist on call if one of these
modalities is to be used. If the procedure is on a pediatric patient,
the clinical team must arrange for the pediatric sedation team to
handle the patient sedation.
- Weekends: On a routine weekend, the fellow will be expected to be at the hospital at an agreed upon time on Saturday and Sunday to read out all inpatient/ER cross-sectional imaging studies and the necessary MSK plain films with the faculty. Additional outpatient MR and CT studies from Fontaine will be read out on the weekend as well.
- ER Studies: As a part of being on-call approximately every seventh weekend, each fellow will be expected to staff out MSK films from the ER with the on call resident on Saturday at 4:30 pm and Sunday at 5:30 pm. Fellows actually have less call than the faculty and will be expected to work longer hours than the faculty when on call. An example of coverage in 2011:
- “Morning” ER Coverage: Read out overnight resident at 7 AM
Read out day time resident at 12 Noon
- “Evening” ER Coverage: Read out day time resident at 4:30 PM Saturday and at 5:30 PM Sunday
Fellows are provided with written evaluation of their performance four times during the program. The faculty performs evaluations of the fellows' performance at 3, 6, 9 and 12 months through New Innovations.
Anonymous evaluations by the fellows of the program are completed annually, and faculty are anonymously evaluated quarterly. Faculty are evaluated using a numerical scoring system on a wide variety of clinical, teaching, and research skills.
Salary, Benefits and Academic Stipend
Our fellows receive an annual salary that is competitive with what is offered by other institutions. They receive medical and dental care benefits for themselves and their immediate family. Additionally, malpractice insurance is provided at no charge.
Our fellows receive an annual stipend. This stipend is to cover expenses related to attending meetings or buying books. Each fellow is encouraged to attend one educational meeting of his/her choice.
Vacation and Leave Policy
Our fellows have 22 days of vacation time plus additional time off at holidays. Additional time off is granted for fellows presenting at national Radiology meetings.
Fellows have combined office space with several cubicles, separate computers, telephones, and PACS.
Cree Gaskin, M.D.
Fellowship Program Director
The University of Virginia School of Medicine is accredited by The Liaison Committee on Medical Education (LCME). The University of Virginia is an Equal Opportunity/Affirmative Action employer; women, minorities, veterans and persons with disabilities are encouraged to apply.