Radiology subspecialisation in Africa: A review of the current status

Abstract

Background: Radiology subspecialisation is well-established in much of Europe, North America, and Australasia. It is a natural evolution of the radiology speciality catalysed by multiple factors.Objectives: The aim of this article is to analyse and provide an overview of the current status of radiology subspecialisation in African countries.Methods: We reviewed English-language articles, reports, and other documents on radiology specialisation and subspecialisation in Africa.Results: There are 54 sovereign countries in Africa (discounting disputed territories). Eighteen African countries with well-established radiology residency training were assessed for the availability of formal subspecialisation training locally. Eight (Egypt, Ethiopia, Kenya, Morocco, Nigeria, South Africa, Tanzania, and Tunisia) out of the 18 countries have local subspecialist training programmes. Data and/or information on subspecialisation were unavailable for three (Algeria, Libya, and Senegal) of the 18 countries. Paediatric Radiology (Ethiopia, Nigeria, South Africa, Tunisia) and Interventional Radiology (Egypt, Kenya, South Africa, Tanzania) were the most frequently available subspecialist training programmes. Except Tanzania, all the countries with subspecialisation training programmes have ≥ 100 radiologists in their workforce.Conclusion: There is limited availability of subspecialist radiology training programmes in African countries. Alternative models of subspecialist radiology training are suggested to address this deficit.

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“…The role of radiology has evolved from merely medical imaging for diagnostic purposes to utilisation of medical imaging approaches to aid in interventional diagnostic and therapeutic uses [15] . In sub-Saharan Africa there is a lack of interventional radiologists due to lack of resources and expertise hence the conventional open approach for even biopsies for histological analysis is still employed [16] , [17] . Once a metastatic disease is identified the oncological puzzle to look for the primary begins [18] .…”

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“…The situation in developing countries such as Africa is much worse, with the ratio being under one radiologist per 1,00,000 population. 5,6 With an increase in the population and the number of radiological examinations performed each year, the relative number of qualified radiologists is declining, resulting in backlogs and delays in timely medical imaging even in large organisations like the UK-National Health Service and the US-Department of Veterans Affairs. [7][8][9] Consequent to the increase in the volume of scans, and a decrease in the number of radiologists, are the issues of increasing radiologist burn-out and high interpretation errors.…”

Factors Influencing the Choice of Radiology Subspecialty Among Radiology Trainees in Sudan

“…The radiology subspecialty must comprise a distinct area of knowledge that cannot be incorporated into the general radiology curriculum. In addition, it must have unique applicability backed up by evidence of improved patient care that a subspecialist's skillset can offer, and structured formal training with apparent benefits that do not negatively impact the existing general radiology training or other radiology subspecialties [ 2 ]. Many factors that drive the interest of a radiologist in pursuing further fellowship training have been identified in the literature, some of which are personal, such as the chance of improving career prospects, while others are job-related [ 3 - 8 ].…”

“…Africa suffers from a chronic lack of access to radiology training programs, both at the level of the diagnostic radiology (DR) residency and the radiology specialty (RS) fellowship. It has been shown that only 18 of the 54 sovereign African nations (excluding disputed territories) report having well-established DR residency programs, and only eight of those nations report having any subspecialty programs, with information being readily available for only five of them: Egypt, Ethiopia, Kenya, South Africa, and Tanzania [ 2 ]. In Africa, radiology postgraduate residency and subspecialization appear to have lagged behind the rest of the world [ 2 ].…”

“…Sudan, a developing African nation, faces numerous obstacles to successfully adopting radiology subspecialization. These challenges include a lack of financial resources and knowledge, inadequate infrastructure and equipment, politics, and the emigration of radiologists to foreign countries [ 2 ]. Only four vascular interventional radiologists (VIR) are currently employed in Sudan (all of them practicing in the country's capital, Khartoum), which illustrates the current state of radiology fellowship in the country.…”