Fellowship Director: Leon Rybak, MD
Philosophy
Within the division of musculoskeletal radiology at the New York University Medical Center and Hospital for Joint Diseases, we place great emphasis on education. We see it as our responsibility to provide guidance, mentoring and a certain amount of didactic material to the fellows training under us. It is also true that there is no better way to learn than by doing. Fellows who take an active role and approach the everyday work with enthusiasm will get much more out of the experience. We ask our fellows to take the time to preview the studies and form their own opinions as to the findings and clinical implications. This way, we find film review to be more interactive and rewarding.
We cover the Hospital for Joint Diseases (HJD) , the New York University Hospital Center (NYU), the Manhattan VA Hospital (remotely) and Bellevue Hospital Center. We are also developing teleradiology partnerships which primarily involve MRI. Responsibilities will vary according to the institution. We attempt to make the rotations as consistent and evenly distributed as possible. There are several basic rotations. The nature of the workload on the different rotations is as follows:
HJD
The fellows at HJD are split between:
Film Interpretation – This fellow is predominantly in charge of previewing the daily MRI/CT cases, reviewing them with the attending assigned to this area and dictating the cases. All cases for the following day should be protocoled in advance. This fellow will also help with the interpretation and dictation of the teleradiology cases.
Procedures – This fellow will be in charge of helping to prepare for and perform the interventional procedures at HJD. They are asked to review the list of cases either the night before or the morning of , make copies of any old relevant reports and retrieve any available films. This fellow is responsible for helping to ensure that the workflow and patient through-put in the procedure area is maintained. Patient’s will be interviewed, a brief history and physical performed and consent obtained at the nurses station prior to proceeding to the procedure room. The fellows will be trained in all procedures performed at the Hospital for Joint Disease including epidural spine injections, facet blocks, myelograms, lumbar punctures, discography, arthrography, cine studies, percutaneous biopsies, radiofrequency ablation, cryoablation and therapeutic injections. The modalities utilized include fluoroscopy, computerized tomography and ultrasound.
Bellevue
The workload at Bellevue consists primarily of plain films. Any musculoskeletal MRI and CT cases preformed during the week will be read out as well. There is an occasional CT guided biopsy. The responsibilities and workflow are similar to those at HJD.
New York University Medical Center (Tisch)
The workload at Tisch consists primarily of MRI and, to a lesser degree, CT. There may be up to three arthrograms a day performed at Tisch. Most of these will be performed by the fellow to ensure continued workflow and patient throughput.
Conferences
We have a busy conference schedule at HJD. The morning conferences in bold below are mandatory. The other conferences are optional. The weekly conference schedule at present is:
Monday – MRI Interesting Case Conference
The interesting MRI cases from the prior week will be presented and the findings analyzed by the fellows with discussion by the group to follow.
Tuesday – Spine Surgery Conference
This is a conference with the spine surgeons where interesting cases and/or consults are presented, the films reviewed by one of the HJD attending staff and the therapeutic options discussed.
Tuesday-Sports Medicine Conference
This is a conference with the sports medicine surgeons. The conference may be case based or take the form of a journal club.
Wednesday – Grand Rounds/Didactic Conference/Journal Club
If the subject of orthopedic grand rounds is considered of interest and value to the fellows, they will be required to attend. On weeks where the topic is not applicable or the conference is not held, a didactic conference by one of the radiology attendings will be substituted. Occasionally, we will have journal club and the articles distributed in advance. At the beginning of the year, Dr. Schweitzer will deliver a series of introductory lectures on MRI physics.
Thursday – Plain Radiograph Interesting Case Conference
Interesting plain films from Bellevue and HJD will be presented. The residents and fellows analyze and discuss the cases.
Friday – Fellows Teaching Conference
This is a case taking conference which is prepared by the fellows and used to teach the residents. The fellow in charge of the conference that week should gather about 7-10 good cases in digital format (digitize them if necessary) and, time permitting, put them in a power point format with some relevant teaching points. The fellow will present the cases and, in conjuction with the attendings present, take the residents through them.
Call Schedule
The fellows will take call for one week at a time beginning on a Monday night and ending the following Monday morning. There is an attending on back-up call for the week available for consultation.
The weekend coverage portion of call involves reading out the inpatient and I-Care (our version of an emergency room) cases each day. The cases read on call will be reviewed and the reports finalized by the attending covering plain films at HJD on Monday.
Vacation/ConferenceTime
Each fellow is allotted 4 weeks of vacation time. Dedicated conference time is allotted only if the fellow is presenting.
