Training of Radiology Residents in Taiwan

The radiology residency program in Taiwan spans four years and follows a structured, time-based curriculum designed to encompass a comprehensive range of diagnostic imaging and interventional radiology specialties [1]. Residents gain expertise in various fields, including general diagnostic imaging, pediatric imaging, neurological imaging (CT and MRI), body imaging (CT and MRI), ultrasound, musculoskeletal imaging, cardiac imaging, obstetrics, breast imaging, body procedures, and interventional radiology.

The first year of training focuses on foundational knowledge essential for radiologists. This includes radiobiology, which emphasizes ionizing radiation safety and protection, the biological effects of radiation, and radiation-induced injuries. Residents also study general radiological physics (excluding MRI), radiographic anatomy, contrast agents, and commonly used medications.

From the second to the fourth year, the training becomes increasingly specialized. Residents delve into advanced diagnostic imaging areas such as pediatric radiology, neurological and body imaging with CT and MRI, ultrasound, musculoskeletal imaging, cardiac imaging, and imaging specific to thoracic, genitourinary, and obstetrics/gynecology systems. Training also covers breast imaging, including mammography and stereotactic biopsy, as well as body interventional procedures.

The residency program integrates various educational activities to enhance learning and professional development. Residents are required to attend annual and regional meetings, which provide opportunities for case discussions and sharing expertise. Regional meetings are held in rotation among northern, central, southern, and eastern Taiwan and are hosted by different teaching hospitals. Residents also participate in imaging interpretation tests, introduced in 2007, conducted quarterly to assess diagnostic skills. Additionally, a biennial program on medical physics and the essentials of diagnostic radiology, initiated in 2014, is hosted at various locations across Taiwan to ensure accessibility for all participants.

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Working Conditions and Compensation

In terms of compensation, radiology residents in Taiwan receive salaries comparable to those in other medical specialties, typically ranging from USD 2000 to USD 3000 per month. Working hours are regulated under the Labor Standards Act Applicable to Residents in the Medical and Healthcare Industry [2], implemented on September 1, 2019. This legislation specifies that patient care services, on-call duties during nights or holidays, and mandatory meetings are considered working hours. However, voluntary participation in continuing education or non-mandatory meetings is excluded, provided such activities neither influence evaluations nor result in penalties for non-attendance.

Working hours are capped to mitigate excessive strain. Regular shifts are limited to a maximum of 13 hours, while non-duty days are restricted to 10 hours. On-duty days in a non-shift system may extend up to 25 hours, but breaks are mandated during these periods to safeguard residents' well-being.

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Accreditation of Training Hospitals

Radiology residency training in Taiwan is supported by 39 accredited hospitals, which are evaluated annually based on established standards. To qualify for specialist physician training, a teaching hospital must employ at least five dedicated radiology specialists, each with a minimum of two years of experience in their respective specialties. Evaluation standards for teaching hospitals emphasize a well-defined training policy, qualified instructors, and a robust curriculum that specifies detailed training components, durations, and evaluation methods [1]. Hospitals are also required to provide adequate resources for resident education and maintain mechanisms for teaching evaluations and feedback. Accreditation results directly influence the number of residents each hospital is authorized to recruit.

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Competency Assessment

Assessing resident competency is a vital component of the radiology training program. Taiwan has adopted the Diagnostic Radiology Milestones, derived from the Accreditation Council for Graduate Medical Education framework, to systematically evaluate residents' progress. Workshops introducing these milestones were conducted in February 2020 and March 2021. Moreover, the concept of Entrustable Professional Activities has been incorporated to assess residents' capability to independently perform specific diagnostic and interventional tasks.

Although these systems represent significant advancements, their implementation remains limited to selecting training centers and is not yet universally adopted across Taiwan. Nonetheless, competency assessment combines objective measures, such as imaging interpretation tests, with subjective evaluations through feedback mechanisms.

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CONCLUSION

The complexity of radiology necessitates a multifaceted approach to residency training and evaluation. Taiwan's program seeks to balance foundational knowledge, specialized expertise, and rigorous competency assessment. Efforts to standardize evaluation methods nationwide and maintain consistency in training quality are ongoing. Implementing quality assurance measures, such as calibration sessions and inter-rater reliability exercises, will be critical to achieving uniformity and fairness across training centers. By continually refining its strategies, Taiwan aims to develop highly competent radiologists capable of addressing the evolving demands of modern medical practice.

References

1. 1. Taiwan Radiological Society. The planning and implementation of the radiology specialist physician system (for training hospitals). [accessed on December 5, 2024]. Available at: https://www.rsroc.org.tw/papers/papers_ detail.asp?id=183. 2. 1. Bureau of Labor Insurance, Ministry of Labor. The resident physicians hired by the medical, healthcare and care-giving industries (not including the physicians employed by public medical institutions according to relevant civil servant regulations) shall be applicable to the Labor Standards Act with effect from September 1, 2019. [accessed on December 5, 2024]. Available at: https://www.bli.gov.tw/en/0014626.html?iPage=2.