Training Clinician Scientists for Radiology's Future
From patient impact to pipeline reform—a look inside a research-integrated residency track
Melina Hosseiny, MD, was a medical student when her nephew, who was born with a congenital disease, became very ill. Searching the internet for shreds of hope, Dr. Hosseiny’s sister discovered a research paper from Japan on a potential treatment that might help her child.
“I was able to see firsthand how the work of researchers helps people around the world, often without them even knowing it,” said Dr. Hosseiny, a radiology resident at the University of California, Los Angeles.
The experience inspired Dr. Hosseiny to pursue a research fellowship and ultimately, the clinician-scientist track within the radiology residency program at the University of California, San Diego (UCSD). It is one of a handful of similar curricula supported by National Institutes of Health (NIH) T32 grants nationwide.
Another example is the American Board of Radiology Holman Research Pathway, which offers radiology residents at any institution a mechanism for securing protected research time early in their training.
Dr. Hosseiny completed her NIH T32 research year at UCSD, followed by two clinical years there before transferring to UCLA for residency. She has continued her research at UCSD where she also receives mentorship.
“There’s so much value in the clinician-scientist track,” Dr. Hosseiny said. “It trains a specific type of radiologist who can bridge the gap and be fluent in both clinical language and scientific inquiry.”
In an editorial in RadioGraphics, Dr. Hosseiny and her co-authors called for more NIH/T32 grant-supported clinician-scientist tracks, citing a primary focus on clinical training in most radiology residency programs. The current radiology labor shortage, they argued, further threatens the pipeline for clinician-scientists who are essential for advancing imaging technology in patient care.
A Model for Building the Pipeline
Robert Mattrey, MD, formalized a clinician-scientist track for UCSD residents in 2003 to help generate a cadre of physicians to push the frontiers of radiology.
“Clinician-scientists create new things, new opportunities and make impactful discoveries that then can change the field altogether,” said Dr. Mattrey, now a professor of radiology at UT Southwestern Medical Center (UTSW) in Dallas. “NIH and many others, including RSNA, have provided funds to support physicians to gain scientific knowledge so one person can bridge that space to discover, assess, analyze and put what works into practice.”
Increasing the ranks of radiology clinician-scientists has been historically difficult due to the limited research time in traditional radiology training, inadequate funding and a small pool of candidates.
“The majority of people who decide to go into radiology do so late in medical school for reasons other than research,” Dr. Mattrey said. “From the mid-80s to the early 2000s, when I was allowed to recruit a resident to spend a year in research during residency, I was only able to get a resident every three or four years because they were not interested in research or they didn't want to take time away from their clinical training.”
Based on the overwhelming success of trainees who did their research year before residency, Dr. Mattrey established a clinician-scientist track that adds a year of research before residency, followed by six weeks of dedicated research time during each of the subsequent four years of clinical training. This provides participants with a total of 1.5 years of dedicated research time.
In this research upfront model, the clinician-scientist in training can focus purely on research without clinical expectations for an entire year during the more labor-intensive beginning phases of a project and then have guaranteed time annually during clinical training to continue a project.
“Doing research upfront is ideal,” Dr. Mattrey said. “The successful residents end up publishing eight to nine papers in high impact journals by the time they graduate. They also become known in the scientific community to compete for research-oriented academic positions.”
Early exposure to research has had a profound impact on the career path of trainees. Dr. Mattrey said during their second or third year of residency, many participants in the clinician-scientist track have told him, “If I didn't do that year of research, I'd probably be headed to private practice.”
“The successful residents end up publishing eight to nine papers in high impact journals by the time they graduate. They also become known in the scientific community to compete for research-oriented academic positions.”
— ROBERT MATTREY, MD
During the 13 years Dr. Mattrey ran the clinician-scientist track at UCSD, approximately two-thirds of the participants went into academia—a significant increase from the 15% who did so before the program's introduction.
Since his recruitment to UTSW with the goal of implementing the clinician-scientist model, all the program’s participants since 2017 have entered academia—a prerequisite to becoming a clinician-scientist.
“We receive about 130 NIH/T32 qualified applications for the three clinician-scientist program slots, and every year that number has increased,” Dr. Mattrey said.
The success of both clinician-scientist programs is self-perpetuating.
“Well-structured clinician-scientist tracks supported by mentors who are genuinely invested in training the next generation of radiologists will attract more medical students, and create a positive cycle that sustains itself,” Dr. Hosseiny said. “Graduates of these programs not only serve the field of radiology, but the institution and medical school as well.”
Instituting a successful clinician-scientist track requires a stimulating research environment, access to cutting-edge equipment and facilities, and high-quality mentorship.
“Over the five years of their training, participants in the UTSW program have both a well-funded research mentor and a successful clinician-scientist career mentor that are highly experienced,” Dr. Mattrey said.
For Dr. Hosseiny, the mentors who supported her throughout her career have left a lasting mark on her journey.
“If it weren’t for the incredible people I met along the way, each exceptionally kind and generous with their mentorship, I wouldn’t be the person I am today,” she said. “My goal is to become an academic radiologist and to do the same thing all these amazing people did for me. I want to be able to pay back the community and train the next generation of academic radiologists.”
For More Information
Access the RadioGraphics article, “The Clinician-Scientist Radiology Residency Pathway: Cultivating Leaders in Radiology Research and Innovation.”
Read previous RSNA News stories on radiology career pathways: