The Future - Part 1 from page 7 are beginning to appear commercially, and may set the scene for the future. Interventive Radiology Smaller, smarter, slicker will be the bywords here, but political pressure and the relationship with other mini- mally invasive procedures may be the pivotal aspects. The number of inva- sive procedures may well expand, de- spite the increased involvement of clinical colleagues. This may be partly as a result of the incorporation of pre- viously unguided procedures. The promise of routine remotely-performed procedures ap- pears a long way off, despite huge in- vestments in the technology, particu- larly feedback transducers. The specialty Turf wars, clinical re-alignments, and reimbursement issues may over- shadow technical advances. A major split of the specialty into the hands-on and remotely conducted components may occur, with central- ised or home reporting facilitated for the latter. Organ-specific teams will prob- ably emerge from the turf wars, be- coming the rule in the bigger centres. Medical training may adjust to this concept, with, for example, a career neuroradiologist or technique special- ist commencing training straight af- ter school, in the same way that den- tistry splits from general medicine. Could we witness a backlash against the sterile and remote digital environ- ment, with close personal attention and professional interaction becoming a selling point for some centres, rather than technical prowess? Conclusion Tissue-specificimaging remains our unreachable objective.Non-harmful in- tervention is the ideal. In the attempt, many promising new technologies will go the way of kymography, electron radiography and thermography, while others, at present unknown, may domi- nate. Gradual stepwise progress will hopefully be interspersed by exciting new developments, sending us all back to being students again. The Future - Part 2 The Future - Part 2: Training radiologists- past, present and future Peter Corr MBChB, FFRad(D)SA, FRCR, MMed(UCT) Professor and Head: Department of Radiology, University of Natal, Durban Radiology is one of the most popu- lar specialities in medicine. It is not dif- ficult to understand why. Few radiolo- gists regret making the decision: How- ever the future is not what it used to be: Radiology faces challenges both in South Africa and internationally a SA JOURNAL OF RADIOLOGY. January 2000 which will certainly affect the number and profile of future trainees enter- ing the speciality. Has the "golden age of radiology" truly gone? Doctors training in radiology in South Africa have followed a tradi- tional postgraduate programme as registrars in departments of radiology at the three English language medi- cal schools. They write the College of Medicine fellowship exam within four years of training. At the three Afrikaans language medical schools, registrars write the MMed exams within four years. The medical coun- cil requires four years of training in an academic department for special- ist registration. In many ways the cur- rent South African fellowship follows the UK fellowship exam structure in the late seventies and early eighties with essay type questions, film view- ing and long cases. Today 'the South African Qualifying Authority (SAQA) will effect the curriculum structure, entry and exit points and to page 10 • Exemplary track record - First and original gadolinium - Approved for eNS and whole-body • A benchmark safety record - More than 20 000 000 applications worldwide" • Comprehensive dosage applications' - IV: pre-filled syringes and vials in 10, 15 and 20 ml - Enteral: 100 ml bottle Nïiignevisf [§] MagnevlstO 20 ml: 1 ml solution contains Gadopentetlc acid, Dlmeglumlne salt 469,01 mg, DTPA Meglumlne salt max 1,02 mg. Reg.no,:W/281199. Further Information available on request from Schering (Pty) Ltd, Reg. no. 64/09072/07 • POBox 5278, Halfway House 1685 • e-mail: scherlng@lcon.co.za (1) Data on file Enhancing MRI mailto:scherlng@lcon.co.za The Future - Part 2 (rompageS student assessment of all postgradu- ate training, such as the radiology fel- lowship. One important change will be the necessity for continual assess- ment as part of the final exam mark. Another major impact is the move by the overseas colleges, especially the UK college, to introduce accreditation as the exit qualification after five years as a registrar in training posts. The UK fellowship exam therefore becomes an intermediate and not an exit quali- fication as it is in South Africa. Ac- creditation is compulsory for special- ist registration in the UK. Currently many South African exam candidates are writing the col- lege fellowship exam in their fifth year of training, so making the training in this country de facto five years. The volume and depth of knowledge re- quired to pass the fellowship today requires at least four years training. It is heartening to see that many regis- trars from the Afrikaans speaking medical schools are writing the Col- lege fellowship in addition to the MMed - this is a very positive sign and bodes well for the future of the Col- lege. The College is looking at intro- ducing a number of changes to the syllabus and exam structure to update the course and examination. A log book will shortly be introduced to ensure candidates have performed or at least observed a number of radio- logical procedures before writing the final exams. Macropathology will be introduced into the final exam to en- sure that exam candidates have a good foundation in pathology. More mul- tiple choice questions and short essay questions will be introduced into the final written exam. The number of long cases has been increased from the traditional four to eight and possibly ten cases in future. Many candidates are weak in plain film interpretation and exam emphasis on this area of radiology is required. What of the future? There is no doubt that South Africa and most Western countries will require in- creased numbers of radiologists, not less as was anticipated recently in the United States. I predict that the "brain drain" of radiologists from South Af- rica will continue and may increase. Currently there are 450 radiologists registered here, however it is likely that South Africa will face a shortage of newly qualified radiologists within the next five years unless the number of radiology training posts available is increased. A natural trend will be training registrars in private sector hospitals. It is my belief that the tre- mendous knowledge and experience of private radiologists needs to be bet- ter utilised by medical schools to train registrars especially in high technol- ogy areas such as MR imaging. Fu- ture radiologists will work increasingly with digital images on workstations to improve productivity and cost ef- fectiveness. The widespread enthusi- asm for teleradiology in this country is the forerunner of our move to the digital world. With these rapid tech- nological advances, the future regis- trar will need to be computer literate and be comfortable working and learning in the digital world. The days of swotting from three volumes of "Grainger and Allison" will disappear and be replaced by one CD-Rom~ Perhaps registrars will be tutored or lectured by academic radiologists from a US medical school via a videoconference or satellite link, mak- ing the dwindling number of local professors of radiology obsolete] Such is the price of progress. Neurology SASMO (Medical Oncology) The XXIII Biennial Congress of the Urological Association South African Society of Anaesthesiologists Congress 8-11 March 17-19 March 2000 2000 26-30 March Champagne 19·23 March 2000Sports Resort, CSIR Centre, Baxter Theatre Drakensberg Pretoria 2000 Complex, Rondebosch, ICC Durban Cape Town Weody Grootveld Ronelle van Loggereoberg Tel: (011) 803-9169 Tel: (012) 354-1514 Neville Muoieo Sally Elliott Tel: (031) 260-1607 Tel: (021) 448-6381 10 SA JOURNAL OF RADIOLOGY. January 2000