Cornell University Hospital for Animals

 

Veterinary Diagnostic Imaging


Veterinary Diagnostic Imaging Residency Program

The American College of Veterinary Radiology (ACVR) accredits Cornell’s residency program in Veterinary Imaging. This 4-year program generally enrolls one new candidate each July and provides specialty training in radiology, fluoroscopy, ultrasonography, nuclear medicine, computed tomography, and magnetic resonance imaging in small and large animals, and radioiodine treatment of hyperthyroidism in cats. Currently there are 5 residents enrolled in the program (the class size will return to 4 residents in July 2018). Successful completion of the program qualifies candidates to take the ACVR board-certification examination, and prepares candidates for academic or specialty practice. For equally qualified candidates, preference is given to candidates with a documented history of interest in academic practice.

Film-readingPotential Applicants

Applications are managed through the Veterinary Internship and Residency Matching Program unless otherwise specified. Applicants must have a degree in veterinary medicine, and at least one-year post graduation clinical experience: completion of an internship is strongly encouraged. English proficiency is required (both written & spoken). Foreign applicants are eligible and encouraged to apply. For successful international candidates, the College provides assistance with obtaining a visa.

The application includes a letter of intent, transcript, and three letters of recommendation. Applicants may visit the facilities to learn more about the program: visitation dates are limited and must be scheduled through our Imaging Administrative Assistant, Katlyn Wilcox (dcs-wilcox@cornell.edu). Only about a half of the successful candidates visit our program prior to acceptance: therefore, visiting the campus is not required for acceptance into the program. Also, phone or Skype interviews initiated by candidates are discouraged. Imaging Faculty may decide to contact applicants for additional information or request a visit under special circumstances. Candidates that have questions about the program may email the residency program director, Dr. Peter V. Scrivani (pvs2@cornell.edu). Applicants attending the annual ACVR Scientific Meeting also are encouraged to speak with any of the Imaging Faculty attending the meeting.

When preparing an application, the letter of intent should discuss the applicant’s motivation for seeking a residency in veterinary diagnostic imaging, how completing such a program would help achieve their specific future career goals, and why this program would help meet those goals. Residents also should discuss what skills and talents they will bring to the program. Letters of recommendation should be written by individuals who are qualified to comment on cognitive/clinical reasoning, technical, and communication/interpersonal skills of the applicant. Each referee does not have to comment on all three aspects, but the group of referees should cover these items. It is recommended that at least one letter is from a board-certified veterinary radiologist. Ideally, current supervisors should provide letters. Letters from peers, friends, or supervisors from long ago do not carry much weight.

The number of applicants (as for most residencies) exceeds the number of available positions. Furthermore, only a percentage of the qualified applicants typically are ranked. Those candidates who are successful tend to be self-motivated, independent, leaders who are accepting of new experiences and perspectives and efficient at time management. Successful candidates also tend to have a high GPA/rank, a strong rotating internship or equivalent work experience, a thoughtful and interesting letter of intent, English proficiency, exceptional letters of recommendation, and a documented ability or willingness to work well with people, large animals, and small animals. Other qualifications (e.g. publications, research experience, and teaching experience) are helpful when ranking individuals who have made the final cut.

McGraw Tower, Cornell UniversityWhy Choose Cornell?

Cornell University is a world-class research intuition in the beautiful Finger Lakes region of New York State that offers many educational, social, and recreational opportunities. The College of Veterinary Medicine has been a part of Cornell University since its foundation over 150 years ago and is recognized as a global leader in animal medicine, public health, biomedical research, and veterinary medical education. The College has a clear commitment to diversity and inclusiveness, and the faculty, staff, and students are compassionate and dedicated to service at the state-of-the-art teaching hospital.

The post-graduate study of veterinary diagnostic imaging at Cornell is rigorous and wide-ranging. We have on-site facilities for each of the five core imaging modalities used in veterinary medicine, a robust caseload in small and large animals, and access to specialists in veterinary medicine and other related fields like biomedical engineering. The Veterinary College at Cornell employs five board-certified veterinary radiologists, an ACVR/RO Diplomate, and dozens of other veterinary specialists. The Imaging Faculty are committed to resident training, provide direct on-the-floor supervision and mentoring to residents, attend daily case rounds, and engage in timely case discussions with the residents. The Cornell University Hospital for Animals (CUHA) also employs seven dedicated and experienced imaging technicians.

The residency program at Cornell is well established and, since its initiation in 1999, residents completing the program have had an excellent pass rate for the ACVR board-certification examination, about a third have accepted academic positions, and many are leaders in the field. The Imaging Section also offers an online teaching file with nearly 10,000 entries, access to numerous online journals through the Flower-Sprecher library, and a software program that displays the resident’s draft written report side-by-side with the Faculty’s finalized report for direct feedback by comparison.

IMAGING FACILITIES
• Two multi-plate AGFA CR readers (small animal & large animal)
• Multiple wireless DR detectors
• Phillips RF special procedures room
• Flat-panel Ziehm C-arm for intra-operative imaging
• Toshiba Vantage Atlas 1.5 Tesla MR
• 16-slice Toshiba Aquilion-LB CT
• MIE planar gamma camera system
• Isolation facilities for radioiodine therapy
• Phillips Epiq & IU22 ultrasound units with elastography capabilities
• The equipment is integrated via DICOM modality worklist through the medical record system, and images are archived and viewed with Carestream PACS, including both diagnostic and browser-independent web software.
• Integrated 3-D software is included.
• Multiple diagnostic workstations for image evaluation

CASELOAD
caseload graphThe approximate number of patients seen each year at the CUHA is 25,000 animals. The approximate number of annual imaging caseload is about 10,000 examinations. Each resident generates approximately 2000 written reports each year. Preliminary reports typically are completed within a day and then reviewed by a board-certified radiologist.

PROGRAM STATISTICS
• Number of residents that completed the program and are board certified = 16/17 (94%)
• Number of residents that passed the entire examination on the first attempt = 11/16 (69%)
• Number of residents that passed the certifying (oral) examination on the first attempt = 11/16 (69%)
• Number of residents that passed the qualifying (written) examination on the first attempt = 15/18 (83%)

Program Details

Employment as a resident at the CUHA is an annually renewable appointment for all services, and employment through the intended term (4 years for Imaging) is contingent upon successful performance of the outlined duties, successful assimilation into the working team, a valid visa status (if applicable), continued funding, and programmatic needs. Resident evaluations are performed after 90 days and again in April and October each year. Depending on available resources, the Imaging Section annually contributes funds to the resident’s discretionary account after successful review. These funds may be used for conferences, textbooks, externships, and other approved educational opportunities The Imaging Section also pays the annual ACVR dues for residents in the program. Employment is contingent on agreement to a covenant not to compete, which precludes veterinary practice during and for two years after employment within a specified distance of CUHA (20 miles for small animal emergency or primary care, 40 miles for large animal emergency and primary care, and 75 miles for specialty practice). Residents are required to obtain written permission from their section chief and hospital director for any type of employment outside of CUHA during their training program.

x-rayON CLINICS
During the first year of the program residents will spend most time on radiography and ultrasonography, especially large-animal imaging. The remaining years will progressively include more advanced imaging technologies like CT and MRI in all species. The first week of the program is specifically dedicated to mandatory hospital orientation. The next month is primarily dedicated to working with the technicians to learn how to use the imaging equipment. Additionally, during this initial period, the resident must attend and successfully pass Cornell’s Radiation Safety class to assist with radioiodine treatment in hyperthyroid cats. For the remainder of the program, the resident is expected to provide imaging services in the CUHA under the supervision of the Imaging Faculty, which includes performing special procedures, interpreting all types of imaging studies, and performing interventional procedures (eg, fine-needle and core biopsies, radioiodine treatment). Residents also may participate in outpatient examinations or consultations (especially during the latter years). Residents are assigned to clinics for 38.5 months during the 4-year program.

Residents are expected to show continuous improved proficiency in producing and interpreting medical images as well as communicating results accurately and efficiently (both orally and written). When assigned to clinics, residents should be accessible, professional, prepared to perform imaging examinations, provide oral interpretations to students and clinicians, and conduct rounds with the veterinary students. Appropriate floor management involves supervision of image quality, facilitating that procedures are performed and interpreted accurately and timely, and being aware of what is occurring presently and what needs to be accomplished that day. Excellent client and peer communication skills and the ability to work collaboratively as part of a clinical team are essential. At least 90% of all preliminary written reports should be completed within 24-hours of image acquisition. These reports are finalized by the faculty or resident after case review with the chief-of-service: residents are expected to increasingly finalize reports as they progress through the program. Residents must review written reports finalized by the faculty member to acknowledge any change made to their preliminary report or observe the style of reporting of that faculty. Residents also are expected to follow-up on cases, which include pursuing results of laboratory tests, observing in the operating room, or attending the necropsy examination.

OFF CLINICS
During the 4 years, residents are assigned off-clinics for 38 weeks: first year, 4 weeks; second year, 8 weeks; third year, 12 weeks; and fourth year, 14 weeks. The responsibilities of the resident during the non-clinical portion of the program are prescribed for some weeks. These include 2 weeks for echocardiography, 10 weeks for study for the qualifying examination (6 weeks during the third year and 4 weeks during the fourth year), 2 weeks to take the ACVR board-certification examination (1 week during the third and fourth years), 1 week to attend the ACVR annual scientific meeting (fourth year), 2 weeks to pursue job interviews (fourth year), and 8 weeks for vacation (2 weeks per year). Vacation may not be taken during the last month of the program. The non-prescribed weeks are for additional professional development such as board-preparation, teaching preparation, attending conferences, and completing research projects (some of these tasks also will be performed after hours, weekends, or during clinics). Off-clinic time may not be taken during the first 6 months of the program without permission of the imaging faculty. Except for vacation, the resident is expected to work full time while off-clinics.

Residents are expected to attend morning rounds when off-clinics (the only exceptions are vacation, externships, attending approved conferences/lecturers/seminars, and the 4 weeks prior to the qualifying (written) examination). Residents may be assigned to emergency call while off-clinics. In general, as a minimum, the resident is not scheduled for emergency during the 4 weeks prior to the qualifying examination.

The resident is expected to rotate through cardiology for two weeks to learn echocardiography. The resident must arrange this rotation with the Cardiology Service at Cornell or as an externship with a qualified person such as a board-certified cardiologist. Whereas the focus of this program is on diagnostic imaging, residents are expected to learn imaging-guided fine-needle aspiration and tissue-core biopsy. Additionally, residents are expected to participate in cardiovascular catheterizations when available. The resident might use some of the off-clinic time to perform an externship, such as to learn interventional radiography. The Imaging Section usually does not directly fund externships. The resident also is expected to review all on-line teaching resources and teaching files.

ultrasoundEMERGENCY
Residents must be able to use all the imaging equipment within the section necessary to perform emergency procedures: a technician is on-call to perform MRI examinations. On-call duty is shared fairly among the residents. Residents provide primary consultation, but have an assigned Faculty member--or senior resident and Faculty member--for back-up support. When scheduled on emergency, the resident must be available in person, and by phone. The resident is expected to respond to all calls in less than 30 minutes (including having access to a computer for remote consultation or to arrive at the hospital for procedures). Residents are compensated for performing US, CT, and MRI examinations on emergency. The funds are deposited in a discretionary account and may be used for conferences, textbooks, externships, and other approved educational opportunities.

Whereas a faculty member is always assigned to provide backup support to the resident on emergency, the expectation of the emergency-rotation experience is for the resident to develop and demonstrate independence on the clinic floor. Demonstrating independence includes BOTH successfully performing examinations without faculty support and requesting faculty help when appropriate. If the emergency service requests faculty support, the resident will call the backup faculty. If there is any controversy about a case, then the resident is expected to call the backup faculty for advice on how to deal with the situation.

MORNING RESIDENT ROUNDS
These rounds are offered every day except when there are scheduling conflicts (e.g. meetings, lectures). With little exception, all Imaging Faculty and residents attend these rounds whether scheduled on or off clinics. On Monday, Tuesday, Wednesday, and Friday, the intent of these rounds is to review the over-night cases, to showcase and discuss select cases from the previous day, and to discuss special procedures to be performed that day. The rounds are directed toward optimizing patient care and resident learning. Residents are expected to professionally present cases focusing on the imaging signs and how that affects patient management. Residents should prepare for rounds by reviewing relevant clinical data (including test results) and pertinent literature. Residents are expected to answer impromptu questions asked by Faculty or other residents. On Thursday, morning rounds are dedicated to resident learning through Known Case Conference or Journal Club.

catscanBOARD PREPARATION
Meeting specialty board requirements is the responsibility of the individual resident. The section supports individual efforts through Known Case Conference and Journal Club (see below), but does not offer formal courses as part of the residency program. Residents are expected to engage in self-directed study of the objectives for the qualifying portion of the ACVR examination. Many of these learning issues are reinforced on the clinic floor and during morning rounds. Therefore, residents are expected to be self-motivated, organized, and take charge of their educational experience. Examples of successful behavior include organization of book club to review specific topics, self-initiated literature reviews, and asking Faculty for clarification of complex topics. Residents also are expected to attend College or Hospital seminars when topics are relevant to veterinary imaging: Tumor Board, Pathology Rounds, etc.

KNOWN CASE CONFERENCE (KCC)
As part of board-examination preparation, KCC is offered every other week and is attended by all the imaging residents and faculty. In KCC the faculty selects cases that the resident has never seen, and where the diagnosis/outcome has been unequivocally confirmed. These cases are then presented to the residents as unknowns. These conferences may take different forms (e.g., film, digital, PowerPoint Presentation, slides, quizzes) but are designed to test the progress of the resident's pattern recognition and medical decision-making skills. The resident receives immediate feedback from the faculty.

JOURNAL CLUB (JC)
JC is offered every other week (opposite of KCC) and is an opportunity for the imaging faculty and residents to review and discuss the medical literature. Articles may be recently published, related to a current topic of interest, or a seminal article previously published. The articles preferentially are selected from the current veterinary literature and must relate to medical imaging. Articles also may be selected from the human literature.

The goals of JC are for the resident to establish a life-long habit of staying current with the medical literature, to review the current literature for board-examination preparation, and to develop the skills necessary to perform critical evaluation of the medical literature. The latter is necessary to:
• Determine if the manuscript will alter how the resident performs medicine
• Perform peer review of a manuscript
• Help design future studies

For JC, the group of residents select up to four articles and must distribute them to the whole group on the Friday prior to discussion. All participating members are expected to read the articles and be prepared to discuss the articles. Residents will briefly introduce the topic of the article and address the study design and how it generalizes to clinical practice relative to improving patient care—as if performing peer review. Next, the resident will lead a conversation about the general topic of the paper.

reading imagesSTUDENT ROUNDS
The intent of this activity is for residents to develop skills with small-group teaching. During rounds, each veterinary student on rotation will be asked to interpret unknown cases. Residents are expected to moderate rounds and provide feedback about the case presentation and teach concepts related to the particular rounds topic. Residents also are expected to participate in determining student grades based on this experience.

TEACHING IN THE DVM CURRICULUM
The intent of this opportunity is for the resident to gain didactic teaching experience, especially with larger audiences. The first-year resident is expected to attend all imaging lectures and laboratory sessions in VTMED 5100 (canine anatomy course) and VTMED 5510 (introductory diagnostic radiology course). Throughout the program residents also participate in additional courses that are taught by the faculty, and provide a lecture in VTMED 6502 (advanced imaging course). The second-year resident also gives an annual lecture to the student-driven “Radiology Club” on a topic of their choice. The ACVR requires residents to prepare and deliver a minimum of three presentations throughout the program (this may include presentation of an oral abstract at a scientific meeting). The program gives plenty of opportunity to meet this requirement. Additional opportunities for teaching exist for interested residents, but are not required.

RESEARCH
The intent of performing a research project is to understand how patient care is improved through discovery of new knowledge. Residents are expected to engage in a research project, but the level of involvement may vary for several reasons like professional goals of the resident, available funding, and the unpredictable nature of some projects. In conjunction with a faculty mentor(s), the resident generally is expected to:
• Participate in study design for the project
• Write a grant for funding
• Obtain Institutional and Animal Care Use Committee (IACUC) approval
• Execute data collection and statistical analysis
• Present abstract at ACVR conference (or other comparable forum)
• Publish results in peer-reviewed journal

Residents also are encouraged to write a case report, case series or other manuscript, in part, to better understand the peer-review process and the steps necessary to publish a manuscript.

Residents are expected to attend the Department of Clinical Sciences Resident Seminar Series, which covers topics related to study design, statistical analysis, and professional development. Imaging residents also are expected to complete the on-line instructional foundational course for the University’s formal Responsible Conduct of Research, which covers authorship, peer review, plagiarism, and research misconduct.

ADDITIONAL EXPECTATIONS
Residents are expected to spend a substantial amount of time performing additional activities such as studying, writing papers, participating in book clubs and reading the medical literature. Some of these activities will occur after hours and on weekends. The radiology faculty may assign other duties or tasks on an as-needed basis. As long as the program is compliant with the requirements of the ACVR and CUHA Residency Oversight Committee, the radiology faculty reserves the right to alter the program at any time without notice.