Training of Radiology Residents in Hong Kong Special Administrative Region

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INTRODUCTION

As of October 3, 2024, a total of 427 Radiology Specialists have registered under the Medical Council of Hong Kong (MCHK). Of these, most are Fellows of Hong Kong Academy of Medicine (HKAM) and Fellows of Hong Kong College of Radiologists (HKCR). Since the 1990s, the training of Radiology residents in Hong Kong has been overseen by HKCR. In this article, the background of HKCR, current training of Radiology residents in Hong Kong Special Administrative Region, and future development of training will be elaborated.

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Hong Kong College of Radiologists (HKCR)

HKCR was incorporated in September 1991 and is one of the 15 constituent Colleges of HKAM, which is a statutory body. HKCR includes three Specialties, namely Radiology, Clinical Oncology, and Nuclear Medicine. As of September 2024, a total of 472, 190, and 29 Fellows of HKCR were enrolled in the Radiology, Clinical Oncology, and Nuclear Medicine Specialties, respectively.

HKAM has delegated statutory power to HKCR to devise the training curriculum of the Specialties, accredit training centers, conduct Specialist training, hold professional examinations, and award Fellowship qualification of its three Specialists. In addition, HKCR accredits programs for Continuing Medical Education and Continuous Professional Development. Regular structured training courses, scientific activities, symposia, workshops, and seminars are organized by HKCR. The Hong Kong Journal of Radiology (HKJR) is the official journal of HKCR indexed in EMBASE. Various guidelines and position papers are published by HKCR to encourage best clinical practice in its three Specialties. HKCR also fosters close ties with other international and regional professional organizations and Societies.

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Radiology Specialist Training

Radiology Specialist Training in Hong Kong is governed by HKCR with corresponding Training Regulations and Training Guidelines. To enroll into Radiology training, all trainees must hold registration with the MCHK, which is deemed acceptable by HKCR and must enroll with HKCR at the commencement of training. The total duration of training lasts for a minimum of six years, including four years of Basic Specialist Training plus two years of Higher Specialist Training (Fig. 1). The four-year Basic Specialist Training encompasses one year of post-registration clinical experience outside Radiology in other clinical Specialties (e.g. Surgery, Internal Medicine, etc.) followed by three years of formal Radiology training. Then, a trainee must pass the Joint Final Examination for The Fellowship, which is jointly held by The Royal College of Radiologists (RCR) and HKCR, thereby obtaining the qualification of Fellow of The Royal College of Radiologists (FRCR). This is followed by two years of Higher Specialist Training, which consists of General Radiology Training and Subspecialty Training. Each trainee must undergo at least nine months of General Radiology Training (including one month of PET-CT training), and training in minimum two Category A Subspecialty subjects (Table 1); of which, training in one subject should be of at least six months duration. The remaining period of Higher Specialist Training can comprise General Radiology Training, Category A Subspecialty subjects or Category B Subspecialty subjects (Table 1). After completion of the Higher Specialist Training, the trainee can apply for Exit Assessment of HKCR. A successful candidate will become a Fellow of Hong Kong College of Radiologists (FHKCR). Subsequently, he/she can be nominated to become a Fellow of the Hong Kong Academy of Medicine (FHKAM); FHKAM (Radiology).

Fig. 1

Summary of the 6-year training path of radiology residents in Hong Kong. RCR = The Royal College of Radiologists, HKCR = Hong Kong College of Radiologists, FRCR = Fellow of The Royal College of Radiologists

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Table 1

Category A and Category B subspecialty subjects in higher specialist training

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All Radiology training centers in Hong Kong must be accredited by HKCR every five years. Currently, there are twelve accredited Radiology training centers, all of which are public hospitals under the Hospital Authority of Hong Kong. All training centers are accredited for Basic Specialist Training and Higher Specialist Training in General Radiology, while individual training centers are accredited for training in various Higher Subspecialty subjects.

There are trainers and co-trainers to supervise the training activities. For General Radiology training, all trainers are Fellows of HKCR while co-trainers can be radiologists possessing other qualifications but individually approved by HKCR. For training in Subspecialty subjects, all Subspecialty trainers must fulfil stringent requirements and be individually approved by HKCR. Before granting the status of Subspecialty trainer, HKCR evaluates individual radiologists on their previous training in the Subspecialty subject; work experience; clinical duty pattern; availability of publications, presentations, and lectures; and attendance of educational activities pertinent to the Subspecialty subject. Subspecialty co-trainers also need to be individually approved by HKCR, and they need to fulfil some but not all the requirements of Subspecialty trainers.

During Radiology Basic Specialist Training, the trainer to trainee ratio is always no less than one to three. During training in Subspecialty subjects, the trainer to trainee ratio is always one to one. All the trainees are employees of the Hospital Authority as residents and can rotate among different Radiology training centers to increase their training exposure.

All Radiology trainees must fulfil the requirements of corresponding training programs under HKCR. These include many elements, such as workload of various imaging modalities, attendance of clinical radiological conferences with case presentations, attendance of mandatory training courses of HKCR, which not only include lectures related to image interpretation but also lectures on radiation safety and protection and statistics. All Radiology trainees are required to submit at least one radiological article to the HKJR or other indexed medical journals with the trainee as the first author. They also need to have at least one project accepted at an HKCR scientific meeting or regional or international scientific conferences with the trainee as an oral presenter or the first author of poster presentation. Moreover, the trainee must submit at least one clinically oriented original audit report in which he/she takes up an independent leading role. With so many elements of the training program, HKCR has devised a comprehensive logbook system for trainees to document the training activities, with regular appraisal by trainers at three to six months intervals. In addition, these records are scrutinized by HKCR at three check points (after completion of Basic Specialist Training, after completion of the first year of Higher Specialist Training, and before Exit Assessment).

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Future Development of Training

Although a well-structured and effective system has already been implemented for Radiology training in Hong Kong, medical education is evolving and HKCR is determined to pursue continuous enhancement of its Radiology Specialist Training. Recently, HKCR has introduced an e-learning course on imaging of pediatric emergencies. Trainees undergo online pre-course assessment, followed by online lecture, image interpretation exercise, and finally online post-course assessment. The training was found to be effective and was welcomed by both trainees and trainers. More e-learning courses will be developed by HKCR on other topics.

Another landmark development in Radiology training by HKCR is the introduction of workplace-based assessment (WBA). From 2025 onwards, Radiology-Direct Observation of Procedure Skulls (RAD-DOPS) will be implemented to evaluate the progress of trainees on interventional procedures during Radiology Higher Specialist Training. It is expected that more types of WBAs will be adopted in the future in various facets of Radiology training.

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CONCLUSION

The training of Radiology residents in Hong Kong is overseen by HKCR. The current training system is well-structured and successful to provide good quality training in Radiology. In future, further enhancements, such as introduction of WBA and e-learning will be performed to enrich the training of Radiology residents in Hong Kong.