In the Czech Republic today, preparation for a career in radiology begins at a radiology department and lasts for four years. The first two years comprise the so-called foundation, of which the first year is common for all fields. The second year is then directed towards individual methods – six months of radiography, two months of radioscopy and four months of ultrasound. The remaining three years are intended for specialised training. This training is divided into:
• The first part focusing on CT training (12 months);
• The second part (24 months) which is further divided into:
» Magnetic resonance (seven months);
» Intervention radiology basics (two months);
» Comprehensive diagnosis of breast diseases (three months);
» Nuclear medicine (two months), and
» Training in one particular radiology field (10 months).
Departments can obtain accreditation for the entire education programme (so-called full accreditation) or for certain of its parts only.
At present, there are eight faculties of medicine and 10 radiology clinics in the Czech Republic. Approximately 30 physicians receive their certifications in radiology each year. The educational system in specialist postgraduate studies has a long tradition in the Czech Republic. Postgraduate studies are organised by the Institute of Postgraduate Medical Education (IPME). This facility, established by the Ministry of Health, has individual departments corresponding to certified areas, including a radiology department.
Relevant departments organise theoretical pre-certification preparation and the actual certification itself. Theoretical precertification preparation is compulsory. The certification exam itself takes place in Prague at the premises of the Institute and consists of a written test, practical interpretation of medical images and theoretical questions. It takes one full day.
Members of the certification committee are appointed on a permanent basis by the Minister of Health based on nominations from a professional radiology society, IPME, faculties of medicine and the Czech Medical Chamber. The certification committee itself has five members, and the chairman of the committee is the head of the department of radiology of IPME or his or her deputy. The certification exam usually takes place twice a year – in spring and autumn. A part of the preparation is the obligation to attend theoretical courses comprising of 200 instruction hours. These courses are chiefly organised by IPME, the Czech Radiological Society and a fully-accredited department.
Transformation of Postgraduate Studies
Prior to joining the EU, the Czech Republic had an established system of two-stage postgraduate studies. Each physician had to receive the first-stage certificate. He or she prepared for this certificate at his or her place of work for three years. Those physicians who wanted to specialise in their field, continuing an academic career or holding leading positions could have passed the second-stage certificate. Preparation for that certification also lasted for three years. Everything was organised by IPME, the relevant department and the certification committee. There were no accredited departments, no established system of residents and fellows. Upon graduating, physicians started working at a department and usually worked there until they retired. They had a permanent work contract.
This system provided for a relatively high quality, although it largely depended on how demanding and high quality the management of the relevant department of IPME was.
After joining the EU, there were a number of legislative changes in the Czech Republic. These resulted in the establishment of a certification committee whose members are appointed by the Minister of Health for the period of four years on the basis of nominations from a professional radiology society, IPME, faculties of medicine, and the Czech Medical Chamber. The certification committee is in particular responsible for preparation of the education programme and certification of departments. Another obligation is that a graduate physician has to begin by working at an accredited department.
Radiology & Nuclear Medicine Accreditation Separate
At present, accreditation in radiology and in nuclear medicine are separate from one another. Nuclear medicine has a common basis with radiology, however, and the two fields are gradually merging. Previously, nuclear medicine was a so-called follow-up or second-stage certification. First a physician had to receive his or her certifications in internal medicine and only then he or she could receive certification in nuclear medicine.
Moreover, the Czech Republic has three continuing professional education courses for further certifications. The continuing education courses in radiology are now interventional radiology, paediatric radiology and neuroradiology. Preparation again takes place at accredited departments and lasts for two years. The education programme is prepared by the relevant accreditation committees for intervention radiology, neuroradiology and paediatric radiology. The exam is organised by relevant IPME departments. Another possibility, which exists not only in radiology but also in other fields, is recognition of so-called certified skills. We are now considering that a certified skill could be a condition for neurointerventions or PET-CT.
The accreditation committee and a professional society are together preparing additional modifications to the education programme, but these are rather minor. There is also ongoing discussion about how to divide the accreditation departments – whether it is better to centralise everything or, vice versa, to allow partial accreditation to as high a number of departments as possible. An issue still remaining open is whether at least the central role of IPME as an organiser and coordinator of postgraduate studies shall be preserved or whether certification, and including the exam, will be organised by individual faculties of medicine.