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Academic radiologists are faced with increasing demands on their time and energy, particularly in the clinical arena, where larger examination volumes and higher service expectations are the norm for most medical centers. These demands are intensified by the continuing shortage of academic radiologists. If academic radiology departments continue to devote most of their resources to the clinical mission at the expense of research and educational missions, then there are potentially serious adverse consequences for long-term viability of the profession of radiology. This dilemma represents a critical strategic problem, not just for academic radiology but also for the entire profession of radiology. In this article, the success and growth of academic radiology during the 20th century are framed as the result of the dogged pursuit of certain key strategic themes. With the concept of paradigm shift, introduced by Kuhn, several new strategic themes are identified that are just emerging from changes in work practices, organizational structure, and mind-sets in radiology departments at academic medical centers. One benefit of this approach is that it facilitates the ability of radiologists to articulate and focus on those strategic themes that will help academic radiology departments to adapt more rapidly and successfully to environmental changes during the 21st century.

Purpose: To develop an Objective Structured Clinical Examination for assessing the reporting skills of radiology residents., Materials and Methods: The approach used in this study derives from performance-based assessment, that is, tests in which actual performance of a skill is observed and measured. For this task, 29 radiology residents and five faculty members (n = 34) independently dictated reports regarding a set of 20 cases with radiographs in 1 hour. The task was performed in a controlled environment. Data were analyzed by using analysis of variance and tests for linear trends, with the expectation of increasing performance with increasing experience., Results: Significant relationships were observed between subjects' experience and the mean number of cases completed (F = 4.46, P =.006), the mean number of well-specified impressions (F = 5.84, P =.001), and the mean number of urgent or discrepant findings noted (F = 3.67, P =.015). Results also demonstrated a clear linear trend of increasing performance with increasing experience with each variable (P =.002, <.001, and.002, respectively, for t tests with polynomial contrasts)., Conclusion: The significant linear trends indicate that reporting skills increase with increasing experience in the program. This finding supports the validity of the measurement. The Objective Structured Clinical Examination provides a means of assessing radiology resident reporting skills.