In conclusion, I'd like to make some suggestions as to how the various participants in vascular and interventional radiology training might apply themselves to its betterment. With turf issues facing us, with major changes in reimbursement and patient referral either here or on the near horizon, with worry that increased emphasis on cost savings and efficiency will diminish funds for training and research, it is common to talk about trying to insure survival of our subspecialty. I would certainly not minimize these concerns or discourage efforts at dealing with them directly. But I do think that the first and best way to respond is to guarantee that those who practice vascular and interventional radiology do so with the best possible knowledge, skill, and judgment, without which all other efforts on behalf of the subspecialty lack a foundation. For leaders of organized radiology, I believe it is time to reconsider the structure and aims of both radiology training and practice. General radiologists are different from vascular and interventional radiologists, who are different from neuroradiologists, who are different from pediatric radiologists, and so on. Their needs and interests are different and, in my opinion, more different than is provided for by current methods of training. For leaders of vascular and interventional radiology, the same considerations apply, and they should participate in any efforts to alter the paths and methods of radiology training. While being careful not to make requirements too rigid (running the risk of stilling growth and innovation), these leaders should also provide guidance to training programs in terms of what knowledge and skills are most important for trainees, and how best they may be taught. Along these lines, it is time to consider methods of training our teachers, and of encouraging performance and creativity in teaching. While there are many superb teachers in our ranks, the majority have developed their skills with very little in the way of formal guidance as to how to teach. Leaders of the subspecialty should also seek ways to overcome turf issues and interact in a productive manner with related clinical specialties, in order to best provide training for the multidisciplinary team concept, which seems the most realistic and sensible approach to patient care at this time. Finally, consideration of how to provide postgraduate training deserves increased effort. Within academic radiology programs, a renewed effort and interest in formal review and design of the program of vascular and interventional training is in order. Examples of detailed curriculum designs for radiology residency programs exist; for vascular and interventional radiology training this work is just beginning. Faculty and chairpersons of such departments need to seek materials, methods, and strategies that will provide a varied and worthwhile educational experience; to encourage basic and clinical research pursuits; and to foster recognition of vascular and interventional radiology both within the department and within the institution. Vascular and interventional radiologists practicing in nonacademic settings, while perhaps seeming to be beyond many of these considerations, can provide an invaluable practical perspective as to what is important beyond the walls of the 'ivory towers.' Such insight would be useful not only in designing residency and fellowship training, but also in guiding programs of continuing medical education. And finally, for the trainees in this exciting field the mandate is what it has always been: to study hard, to learn as much as they can, to develop the skills and desire to make themselves lifelong learners. The faculty of training programs are there to facilitate learning, but they are not the primary cause of learning. This impetus resides instead in the mind of the trainee. Three decades ago, Roscoe Miller published an article on radiology training, the lessons of which remain applicable to training in vascular and interventional radiology. I find it fitting to borrow a quote of Galileo's that Miller used at the beginning of his article to end this one: 'You cannot teach a man anything; you can only help him find it within him self.'
