A CRASH! Response to COVID-19: reflections from the 2020 Roentgen Professorship

Abstract

Each year the Royal College of Radiologists (RCR) awards the Roentgen Professorship to an academic clinical radiologist from the UK to engage trainee radiologists with research.1The Royal College of RadiologistsRoentgen professorship.https://www.rcr.ac.uk/clinical-radiology/awards-and-prizes/roentgen-professorshipDate accessed: May 6, 2021Google Scholar Previous Professors have come from a variety of backgrounds and the awardee does not have to be in a full-time academic appointment.2The Royal College of RadiologistsRoentgen Professor — previous recipients.https://www.rcr.ac.uk/clinical-radiology/awards-and-prizes/roentgen-professorship/roentgen-professor-previous-recipientsDate accessed: May 6, 2021Google Scholar Historically, the Professorship has often been awarded to full-time NHS consultants, underlining the diversity of radiology careers embracing research and other academic activities. The only exclusion is to be already holding a Professorial Chair. The principal duty of the Roentgen Professor, among others such as sitting on the RCR Academic Committee for 2 years, is to visit at least five UK radiology training schemes within the calendar year of the award. These visits usually take place in the first half of the year and involve a programme that may cover research career opportunities, research processes and/or methodologies (e.g., how to submit high-scoring conference abstracts), and more detailed insights into imaging science that are usually particular to the Professor's area of expertise. In this editorial, I reflect on how the COVID-19 pandemic derailed the 2020 Roentgen Professorship, how a rescue plan was formed, and what these experiences revealed about issues that UK academic radiology might face in growing a strong academic workforce for the future. The journey started in earnest in May 2019 after hearing from the RCR Academic Committee that I had been awarded the Roentgen Professorship for 2020. The first responsibility was to organise training scheme visits. In the following months, with the support of Charmaine Mukherjee as Secretary to the RCR Academic Committee, dates were set with the nine training schemes that had expressed an interest, which included a trip to Aberdeen that would see trainees come together from the west and east of Scotland. In addition, I started building a visit programme with the aim of delivering insights into the challenges and rewards of a radiology career involving research, as well as some useful hard skills for trainees to take away. In outline, the planned sessions were: (i) an introductory overview on pathways for academic career progression in radiology, including a survey of the last 10 Roentgen Professors; (ii) a practical workshop session creating a template for the RCR e-poster format; (iii) an introduction to technical research with demonstration examples of three-dimensional musculoskeletal imaging analysis; and (iv) a concluding talk on the history of computed tomography (CT), CT image reconstruction theory, and post-processing in a range of applications from osteoarthritis research, imaging of ancient artefacts,3Dawson J. Turmezei T.D. Recut, refashioned, reused: CT scanning and the complex inner coffin of Nespauershefyt.in: Sousa R. Amenta A. Cooney K.M. Bab el-Gasus in Context, Rediscovering the Tomb of the Priests of Amun. L’Erma di Bretschneider, Roma, Bristol2021: 485-510Google Scholar and populating the latest edition of Gray's Anatomy with cutting-edge radiology.4Standring S. Gray’s anatomy.42nd edn. Elsevier Ltd, Edinburgh2020Google Scholar By the beginning of March 2020, I had completed two of the nine planned visits when it became clear that there was a serious problem ahead. The decision was made on 13 March 2020 to “postpone” training scheme visits because of the COVID-19 outbreak. It did not take long to realise that these would have to be cancelled (Fig 1). The COVID-19 pandemic has led to radical changes in how research, educational, and professional engagement material is now delivered, with virtual content emerging online as the number of cases rose and lockdown took hold (Fig 2). Parts of the science community were quick to adapt and adopt, with a report from Science from 1 May 2020 outlining how the benefits of online strategies such as being able to reach out to international audiences and accelerating remote project collaborations were already being appreciated.5Price M. Scientists discover upsides of virtual meetings.Science. 2020; 368: 457-458https://doi.org/10.1126/science.368.6490.457Crossref PubMed Scopus (28) Google Scholar Given what we know now, the idea of travelling the UK between healthcare institutions to be in a room with trainees seems even more dangerous than at the time the decision was taken to cancel these visits. A communications silence then followed during the Spring to Summer of 2020, with a perceived reluctance to reach out in the clinical world because no one really understood what was going on or just how much others were affected or involved. The first lockdown stemmed rising numbers and by early May 2020 Vicky Goh, chair of the RCR Academic Committee, got in touch to ask if all was well and whether I felt the 2020 Professorship could be rescued. If I had a year of pandemic experience under the belt at that time, I may have felt differently about translating my existing visit programme to a virtual platform, but early feedback had shown that practical sessions in which everyone came together to critique posters and design a template in teams was the most well received. I struggled to see how I could deliver this virtually, so thoughts turned to other parts of the programme. I felt that a practical research demonstration via video link-up was unrealistic and that the keynote lecture could be recorded and distributed at any time (as it has been courtesy of the Department of Radiology at the University of Cambridge7Turmezei T.D. Computed tomography slicing through history.https://radiology.medschl.cam.ac.uk/blog/available-to-watch-computed-tomography-slicing-through-history-by-dr-thomas-turmezei/Date accessed: May 6, 2021Google Scholar). Focusing on the opening careers talk seemed most suitable, with content that included the background, experiences, and current situations of the past decade of Roentgen Professors. Then an idea took shape that we might be able to do more with these experiences, an idea that meant bringing the target audience in to listen rather than travelling out to meet them. In a suitably eureka bath time moment one quiet evening towards the end of May 2020, the concept of the CRASH! Podcast was born. CRASH! would stand for Clinical Radiology Academics Speaking Honestly! A proposal was submitted soon after to the RCR for a series of discussions in which guests from different academic career levels would come together and talk about their life in research, sharing their experiences with each other and, importantly, with an open virtual audience. Radiology podcasts have become increasingly popular in recent years, but there were none at that time serving the interests of trainees wanting to pursue a career involving academic radiology or research, and certainly not specific to the UK, so a gap existed in the market.8Clarke C.G.D. Nnajiuba U. Howie J. et al.Giving radiologists a voice: a review of podcasts in radiology.Insights Imaging. 2020; 11: 33https://doi.org/10.1186/s13244-020-0842-3Crossref PubMed Scopus (10) Google Scholar The RCR approved the proposal and the CRASH! Podcast was given the green light along with its logo (Fig 3). The next challenge was to find guests with appropriate diversity and representation from across the UK. The plan was for a progression of episodes through the equivalent of the National Institute for Health Research (NIHR) Integrated Academic Training (IAT) pathway (Fig 4), starting with Academic Clinical Fellows (ACFs), then those doing a PhD during or at the end of their training, to the Clinical Lecturer or equivalent level, finally ending with Professors. In my mind, diversity meant not only in terms of gender and background, but also in terms of representation from across the UK. In Wales, Scotland, and Northern Ireland the academic training pathways are different, e.g. the Wales Clinical Academic Track (WCAT) in which run-through posts are advertised by specialty, and the Scottish Clinical Research Excellence Development Scheme (SCREDS) that supports clinical academics through to the completion of their training with 20% protected research time.9Health Education and Improvement WalesWales clinical academic track (WCAT).https://heiw.nhs.wales/education-and-training/specialty-training/academic-medicine/wales-clinical-academic-track-wcat/Date accessed: May 6, 2021Google Scholar,10NHS ScotlandThe scottish clinical research excellence development scheme (SCREDS).http://www.scotmt.scot.nhs.uk/specialty/scottish-academic-training-(screds).aspxDate accessed: May 6, 2021Google Scholar I was also determined, coming from that background, to ensure representation from academically inclined NHS consultants that were not in formally funded research posts, as well as from individuals not from the IAT pathway. This was part of a broader mission to reconsider what exactly it means to be an “academic radiologist”. It also required reaching out through personal and wider online networks to find guests willing to take part in the podcast discussions. Guest line-ups can be found along with each episode at the RCR website.11The Royal College of RadiologistsPodcasts.https://www.rcr.ac.uk/college/rcr-learning/podcastsDate accessed: May 6, 2021Google Scholar Given the dour and difficult times that we were experiencing, I was also determined to bring a lighter approach to the proceedings. It did not take long to arrive by association at a quick-fire question round at the start of each episode that would be called the CRASH! Test. This was in no small part inspired by Star Test, a seemingly automated “choose by number” interview show aired on Channel 4 in the early 1990s.12Miles N. YouTube video: channel 4. Star test. Julian clary.1991https://www.youtube.com/watch?v=KLr40qdB1tEDate accessed: May 6, 2021Google Scholar Crucially, guests would not be allowed to know their questions beforehand, so credit must go to them for accepting the challenge in good faith and allowing a glimpse behind their real-life masks. Virtual podcast recordings began in mid-September 2020 under the auspices of Charlotte McKeown from the RCR events team, with the first four episodes released each Wednesday onwards from 21 October 2020; this was by now well into the second wave of the pandemic (Fig 2). The episode featuring Professors would be released in early December 2020 (Episode 5), then the year would close with a final podcast with discussion from female guests on the current state and potential development opportunities for women in academic radiology (Episode 6). An additional role for the Roentgen Professor is to deliver a session at the annual RCR Clinical Radiology Research Day. From the outset, it was planned for podcast guests from Episodes 1–4 to come together on the day (18 November 2020) for a panel discussion at what had been confirmed would be a virtual event; however, practical limitations on holding this session with enough audience engagement led to the idea of the CRASH! Debate. With one returning guest proposing and another opposing one of the six “mini-motions'' set to provoke opinion, the live CRASH! Debate was held at the end of the meeting that saw a maximum of 97 attendees, with 64 still attending online by its close, all of which had the opportunity to vote on the motions. Each “mini-motion” and their results are shown in Fig 5. The debate was recorded and is available through the new RCR e-learning hub (Radiology 2020 Research Day - The CRASH! Debate - discussing the big questions in academic radiology careers) with thanks to Michelle Williams from Edinburgh for her co-moderation of the session.13The Royal College of RadiologistsRCR Learning hub.https://www.rcr.ac.uk/college/rcr-learning/rcr-learning-hubDate accessed: May 6, 2021Google Scholar By the end of April 2021, the accessibility of the CRASH! Podcast was proven by reaching nearly 1,900 downloads across 43 different countries, with the top download locations being the UK (80%), the United States (6%), India (3.5%), and Germany (1.5%). The first episode, Starting out, was pitched specifically at radiology trainees and has been downloaded over 860 times. This is far more reach than a single year of Roentgen Professor visits could achieve (perhaps 100 to 200 individuals) and non-exclusive in its audience. However, this was only the first reflection from the whole CRASH! endeavour. During this podcast run, several threads emerged that looked to be important for promoting UK academic radiology in the future. The first of these was to consider repeating the series in 2021 by revisiting the original guests. Evolution is part of nature, and so the opportunity to come back to these contributors, particularly those at the start of their research career, could deliver further insights into career progression. There could also be an opportunity to expand by inviting international radiologists, industry representatives, and interdisciplinary researchers, including radiographers, physicists, engineers, to engage the broader academic workforce from across the spectrum of clinical imaging sciences. As the series progressed, a second thread appeared from personal feedback through email and social media channels. Although the primary target audience was radiology trainees, the podcast was being picked up not only by radiologists across different career stages, but also by UK medical students and Foundation Programme doctors considering a career in radiology. This raised awareness of the need to engage with medical students as the main recruitment target for both radiology and its academic offshoot. This should be considered central to any future strategy for developing a strong academic radiology workforce and maintaining the UK at the forefront of clinical imaging research. Similarly, but at the other end of the Specialty Training experience, the drive to engage NHS consultants that want to gain research experience was also an important lesson. Hearing the success of clinical radiologists that do not hold formal academic posts, and in particular their positive experiences in engaging radiologists outside of academic centres (see Christina Messiou, Episode 4) pushes for a paradigm shift in exactly how we define and categorise what an “academic radiologist” is. An overwhelming 83% of CRASH! Debate voters were for a research radiologist appointment in every radiology department (Fig 5), the most successful motion win on the day. This suggests there is an appetite for a wider range of academically inclined appointments and should lead to further discussion on how and where academic time is funded and ultimately distributed across the UK for all consultant radiologists. Yet the failure of “mini-motion” 6 to be passed, which proposed that every radiology trainee should publish at least one research paper during training with only 42% for, must lead us to consider carefully what might be an appropriate expectation of all trainees as part of a general curriculum to prepare them for research involvement later in their careers. I sense a significant challenge in carving out more formalised recognition (and, again, funding) for more academic training time for those that want the experience but do not want to or do not get the opportunity to engage in the full IAT pathway. The RCR research certificate is an important ticket for part of that journey, but the specialty of radiology needs to consider how we will best prepare and sustain those with research interests from across all our workforce throughout an entire career.14The Royal College of RadiologistsResearch certificate.https://www.rcr.ac.uk/clinical-radiology/academic-radiology-and-research/research-certificateDate accessed: May 6, 2021Google Scholar Yet another lesson thread related to the experiences gained from creating virtual networks to set up and deliver the podcasts. Through contacts, recommendations, and reaching out through social networks, the CRASH! Podcast was able to build its own network that enabled diversity in our guests as well as finding those with a story to tell. It is worthwhile considering how the academic radiology community can best come together to empower our trainees, developing and strengthening these networks for mentorship as well as project supervision opportunities in the future. The Radiology Academic Network for Trainees (RADIANT) is already taking these steps and starting to deliver output as well as looking to build opportunities to find and develop mentor relationships,15Chan N. Gangi A. Kamaledeen S. et al.RADIANT: the radiology academic network for trainees.Clin Radiol. 2020; 75: 813-814https://doi.org/10.1016/j.crad.2020.07.032Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar while the RCR is currently in the process of updating its online research map that lists academic radiologists from across the UK. Not only did the panel discussion in Episode 1 deliver another thread, but further correspondence from experienced radiologists in leadership and training roles reinforced that radiology trainees face their professional exams at a time that is not conducive to taking up an ACF post in the first year of training, which is the current recommendation. The conflict of prioritising exams versus working on slower-burning research projects (Fig 4) raises the question of whether the IAT ACF structure, timing, and duration are an appropriate model for radiology training. Eighty-one percent of e-voters at the CRASH! Debate were for some kind of change in this respect (Fig 5). Guests from Episode 1 had also reported how difficult it would be to expect trainees to step away almost entirely from clinical training into 3 years of a PhD at the point of passing the FRCR 2B examinations, a stage at which the foundations of long-term specialist clinical skills and knowledge need laying down. The fact that ACF post outcomes are scored by local academic training offices on whether they progress to a higher degree may disadvantage radiology as a specialty in being offered the chance to compete for these positions, even more so if they are pitched against other specialties for whom research is more readily accepted as part of the clinical training experience. Once again we need to look to our medical students and mentor and develop them in imaging research to make sure that we have strong representation at interview that can deliver in the eyes of the ACF post funders, NIHR or otherwise. There should also be ample opportunity to engage intercalating medical students or those in MB PhD programmes (Fig 4) with imaging research projects, but we must be proactive in delivering this supervision and realise there are far more medical school opportunities of this nature than university academic radiology institutions out there. Embracing postgraduate entry students from clinical imaging sciences could also be a rich source for future academic success (see Mark Little, Episode 4). Again, somehow UK radiology needs to broaden its reach to draw medical students into academic activity at an early stage. As for the suitability of the ACF structure, the 4-year term for UK General Practice ACFs that gives an increasing proportion of dedicated academic time after exams demonstrates that it is possible to tailor the IAT experience to an individual specialty, something that academic radiology may need to explore.16UCLAcademic clinical fellowships in general Practice at UCL. Institute of Epidemiology & Health Care, 2019https://www.ucl.ac.uk/epidemiology-health-care/research/primary-care-and-population-health/study/academic-clinical-fellowships-general-practice-uclDate accessed: May 6, 2021Google Scholar,17Nuffield Department of Primary Care Health Sciences, University of OxfordACFs in general Practice — frequently asked questions.https://www.phc.ox.ac.uk/study/academic-clinical-fellows-in-general-practice-oxford/frequently-asked-questionsDate accessed: May 6, 2021Google Scholar For the final thread, it was an important and informative experience to hear directly from all women guests in Episode 6, noting that the podcast was able to achieve greater than 50% female representation (9 ex 17) by that stage. There is no doubting that we have fine examples of strong female leadership in UK academic radiology, and strength coming through to fulfil these roles in the future if the achievements of the podcast guests is anything by which to measure.18Gilbert F.J. Ten lessons of leadership: reflections of a female academic.Clin Radiol. 2020; 75: 799-803https://doi.org/10.1016/j.crad.2020.07.005Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Yet we need to ensure that we maintain an equal platform for the voice of women and other underrepresented groups (such as Black, Asian, and minority ethnic individuals, see Amaka Offiah, Anu Obaro, and Madhu Chetan in Episode 6). It will take more than a podcast to deliver and sustain equity going forwards. Although the traditional Roentgen Professorship format derailed in 2020, the CRASH! Podcast and CRASH! Debate replacement experiences delivered insights into the strengths of a virtual engagement strategy and the growth-to-sustainability challenges that academic radiology now faces in the UK. At the time of publication, a new episode (Episode 7) is being prepared to introduce the 2021 Roentgen Professor, Joe Jacob, who will also be embracing a virtual Professorship experience. It was a pleasant surprise but very much in keeping with many of the podcast discussions that the CRASH! Debate should throw up one tied result, exactly 50:50 on whether virtual research meetings will be the format for the future. Let the debate continue... The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Tom Turmezei reports financial support was provided by Royal College of Radiologists. Tom Turmezei reports a relationship with Elsevier Ltd that includes: consulting or advisory. Tom Turmezei is a member of the Royal College of Radiologists Academic Committee and the National Institute for Health Research Imaging Workforce Group. Opinions expressed in this article are his own and not representative of either body. Tom Turmezei also reports royalty payments from Elsevier Ltd for his role as Imaging Editor on Gray's Anatomy 42nd edition. CRASH! podcast funding was from the RCR Roentgen Professorship allowance. The author thanks all CRASH! podcast and CRASH! Debate guests, in particular Dr Michelle Williams for her moderation of the debate, and Charlotte McKeown at RCR Events, Sue Mercer at 1ASQUARED, the RCR Academic Committee, in particular its chair Professor Vicky Goh, and administrative support Charmaine Mukherjee. T.T. is a member of the RCR Academic Committee and the NIHR Imaging Workforce Group. Opinions expressed in this article are his own and not representative of either body. He also receives royalty payments from Elsevier Ltd for his role as Imaging Editor on the 42nd edition of Gray's Anatomy.