Mission

The Military Health System (MHS), which this program is part of, contributes to the integration of military readiness and health in pursuit of the Quadruple Aim: increased readiness, better health, better care and lower cost for our beneficiaries. The NMCP Radiology Department strives to provide the highest quality radiological services as an integral part of the health care team while pursuing continuous improvement and innovation. The Musculoskeletal Section provides timely and accurate diagnostic information and procedural interventions to support our referring clinicians, the U.S. Navy Fleet and other beneficiaries of the U. S. Government.

Vision

We strive to provide the highest quality diagnostic and interventional musculoskeletal radiological services as an integral part of the health care team while pursuing continuous improvement and innovation. We are a premier force generation platform to develop the future of not only musculoskeletal radiologists but also general radiologists in the military through our collaboration with the NMCP Diagnostic Radiology Residency program.

Aims

1. Provide fellows with a learning experience that enhances development of deep medical knowledge, patient care skills, and expertise applicable to their focused area of practice in musculoskeletal radiology.
2. Always serve the best interests of our patients.
3. Provide for the faculty professional development needs of our department.
4. Continuously evaluate and improve the processes that define our mission.
5. Integrate knowledge, skills, and abilities to achieve the best outcomes.

The didactic curriculum of the NMCP Musculoskeletal Radiology Fellowship is robust and is in many ways closely integrated into that of the NMCP Diagnostic Radiology Residency. Faculty, fellow, and resident-led instruction is designed to cover the full breadth of required topics delineated by the American Board of Radiology (ABR) and ACGME. We leverage a wide variety of instructional methods and resources to accomplish this.

Daily

• Noon Lecture (covering both Imaging and Non-Imaging Curriculum). In addition to participation and teaching engagement on Musculoskeletal Radiology topics, fellows can also participate in continuous education covering the breadth of all diagnostic radiology topics with the residency program.

Weekly

• Joint Radiology & Orthopedics Sports Pre-Operative Conference (Tuesday AM)
• Orthopedic Surgery Residency Academic Day (Friday AM/PM)
• Tumor Boards and other multidisciplinary conferences (various)
• Physics Lecture (Wednesday AM) (optional for fellows)
• Interesting Case Conference (Friday PM) (optional for fellows)

Monthly

• Journal Club
• Joint Radiology & ENT Conference (optional for fellows)
• Morbidity & Mortality (M&M) Conference
• Command Grand Rounds (as applicable)

The academic calendar year is organized into 13, four-week block rotations per year.

Training consists of rotations in general MSK radiology at NMCP, a 4-week funded rotation at Walter Reed National Military Medical Center (WRNMMC) which is evenly split between the WRNMMC Rheumatology Fellowship Program and time training with Dr. Mark Murphey, and a 4-week elective rotation. On-site elective rotation opportunities include Neuroradiology (typically focusing on spine imaging) and Pediatric Radiology. Opportunities also exist for off-site rotations in Pediatric Radiology at Children’s Hospital of the King’s Daughters in Norfolk, Virginia.

All imaging modalities are supported, to include training in radiography, CT, US, MRI, fluoroscopy, and nuclear medicine. NMCP has a full spectrum of cases with particularly robust opportunities in sports orthopedics, spine, bone and soft tissue tumors, rheumatology and podiatry. NMCP has a large primary care and specialist referral base, with NMCP serving as the regional military tertiary care facility. Interventional training includes diagnostic CT, US and fluoroscopic guided arthrograms and biopsies as well as therapeutic procedures, specifically: joint and spine steroid/anesthetic injections; platelet-rich plasma injections, radiofrequency ablations and cryoablations.

Goals and objectives are established for each rotation. Performance evaluation is provided at the completion of each rotation based on ACGME core competencies.

The following is an example of the block rotations throughout the academic calendar year. This may be subject to change based on our Program Evaluation Committee, Program Director discretion, and governing requirements.

* Based on their educational goals, fellows may elect to perform an off-site rotation in Pediatric Radiology or may elect to perform another general musculoskeletal or elective rotation.

Opportunities for elective rotations as above, which may include on-site elective rotations in Neuroradiology (typically focusing on spine imaging) and Pediatric Radiology. Any fellow proposal for an elective rotation will be considered for approval by the Program Director.

We ensure compliance with all ACGME duty hour requirements. As fellows have completed residency and are typically board-eligible or board-certified, they are able to practice independently in their core specialty (diagnostic radiology). While fellows are not typically required to take independent general radiology call, they may do so depending on their education and experience goals for maintenance of knowledge, skills, and abilities, as well as to meet department needs.

• Military Unique Curriculum is blended into our scheduled didactics. This includes shared experiences from previous deployments, panel discussions, and various other professional development activities.
• Residents and fellows are strongly encouraged to participate on multidisciplinary committees throughout the hospital to provide hospital stewardship and to provide leadership skill development.
• Mid-term counseling and mentorship sessions include military professional development and record review.

No specific required courses outside of the above-described curriculum, didactics, and rotations.

The NMCP Simulation Center offers a wide variety of customizable training solutions to augment the clinical experience in Radiology Residency and the MSK fellowship. Here are some examples of previous simulation activities:

• Contrast reaction management
• Ultrasound-guided biopsy skills lab

Leadership curriculum is incorporated into the Military Unique Curriculum.  Fellows may also be nominated to attend external leadership development training in addition to local opportunities.  Some examples include:

• Navy Medical Leader and Professional Development Command courses
• Basic Readiness Officer Course
• Advanced Readiness Officer Course
• MHS Female Physician Leadership Course

Various radiology community forums (for example American College of Radiology, Virginia Radiological Society, Radiological Society of North America, Association of University Radiologists)

Research activity is required during fellowship. Individual trainees often have varying levels of background experience and interest in conducting research. Our goal is to provide foundational training by which all fellows understand the key elements of conducting high-quality research. To that end, formal didactics sponsored by the Clinical Investigation (Research) Department at NMCP are incorporated into the residency (and fellowship) curriculum. We also include research topics in our Journal Club discussions and other Non-Imaging Curriculum. Faculty mentors are available to assist in research projects.

The fellowship year includes dedicated academic time during which the fellow is encouraged to participate in research, process improvement projects, scholarly activities with the radiology residents and in pursuit of self-directed learning. Numerous options for participation in scholarly activity and research exist both within the radiology department and interdepartmentally.

Opportunities for participation in research include:

• Annual NMCP (and subsequent Navy-wide) Annual Research Competition and any other regional or national conference.
• Peer-reviewed journal or conference presentations

Quality improvement activity is required during fellowship. Fellows often complete individual quality improvement projects or may participate in the NMCP Annual Quality Symposium. Training opportunities external to our curriculum exist for those with advanced interest.

See Military Unique Curriculum and Leadership Curriculum sections (above).

Additionally, fellows have the opportunity to participate in Faculty Development courses provided by the USUHS, which offers faculty development certificate programs within the tracks of Teaching, Advanced Teaching, Academic Leadership, Scholarship and Research, Technology, and Simulation.

• Walter Reed National Military Medical Center in Bethesda, Maryland
• Children’s Hospital of the King’s Daughters in Norfolk, Virginia

Medical Students (and various other students/trainees) may rotate through the NMCP MSK Radiology section, however rotations are typically arranged through the NMCP Diagnostic Radiology Residency program rather than the fellowship. Our busy season is between June and October. We attempt to prioritize applicants in the current JGMESB cycle during that time. We encourage student rotators to immerse themselves in the department and identify any specific learning objectives they have up front. Typical rotations include exposure to many of the clinical sections where residents also rotate.

Please see the NMCP Radiology Residency Program website for additional information and to request a rotation.

Interviews are conducted during the designated interview season, generally from July through mid-October. Interviews may be conducted in-person or virtually depending on applicant location/station and availability.

The following required items must be submitted at least one week prior to your scheduled appointment:

• A copy of your current CV.
• A personal statement from you regarding your goals and interests in Musculoskeletal Radiology.

Also, if applicable:

• Provide clarification or contextual explanation regarding any possible adverse information that may appear in current/previous GME documentation or the application packet (to include Dean’s Letter and/or licensing exam failure).
• State any circumstances of co-location with a military spouse, or if you intend to participate in a couple’s match; meaning both you and your spouse are participating in this year’s JGMESB and desire to be assigned to the same location. If so, please include the desired specialty of your spouse.

Contact the program at the email address provided on this website or call the program at 757-953-1165 for information on how to schedule an interview.  Once your information is processed, you will receive an itinerary of the day's events and/or detailed instructions for online video / telephone meetings.

See the Navy GME and Air Force GME websites for more information.

Not applicable. There is no subspecialty board exam for Musculoskeletal Radiology. Prior residency graduates will have taken the American Board of Radiology (ABR) Core Examination during their third year in residency training. To become fully board certified by the ABR, eligible applicants must also successfully complete the ABR Certifying exam which is typically taken 15 months after graduation from residency.

See the ABR website for additional information.

Fellows are required to prepare and present material among the radiology residents, musculoskeletal radiology faculty, and in multidisciplinary settings (including interdepartmental conferences).

Additional teaching opportunities are available based on fellow interest. Examples include resuscitative medicine instructor certification and STEM mentorship at local high schools as schedules permit.

We are proud to have a well-rounded faculty with four musculoskeletal radiologists, in addition to a complement of other subspecialty-trained radiologists throughout the department including Abdominal, Breast, Cardiothoracic, Interventional Radiology, Neuroradiology, Nuclear Medicine, and Pediatric Radiology. We also have several general radiologists who work in each clinical section.

Upon selection to fellowship, you will be paired with a mentor to assist with your transition to our program. During fellowship, you are paired with a faculty mentor and provided dedicated time to meet throughout each year.

Fellow and family well-being is a priority for our trainees.  Fellows are provided dedicated academic and administrative time during each block rotation.  We also look forward to fellow graduation celebration each May as an opportunity to gather.

There are a great variety of recreational activities for families in the local area.  Here are a couple of nearby attractions:

• Local zoo, aquarium, and botanical garden
• Colonial Williamsburg and Jamestown Settlement
• Norfolk Tides (Triple-A affiliate of the Baltimore Orioles) and Norfolk Admirals (East Coast Hockey League)
• Nature trails, camping, and water activities