Interventional Radiology Residency Research Articles

Evaluating the Impact of Annual Resident Retreats on Radiology Resident Wellbeing

To investigate the effect of resident-run wellness retreats on measures of stress, resilience, and cohesion amongst radiology residents. All diagnostic and interventional radiology residents in a single academic medical center were invited to participate in a wellness-focused off-campus retreat. Three retreats were held on an annual basis from 2018 to 2022 and included physical exercises, nutritional wellness, and team-building activities. Participants were surveyed pre- and post- retreat attendance focusing on the following domains: Perceived Stress Scale, higher scores indicating higher levels of perceived stress; Brief Resilience Scale, higher scores indicating greater resilience; Cohesion Scale, higher scores indicating greater cohesion. Paired t-tests and linear regression models were used to compare mean Perceived Stress, Brief Resilience, and Cohesion Scales pre- and post-retreat across covariates. Of 78 total retreat attendances, 75 residents (96%) completed pre- and/or post-surveys. Study population was 51% female and 49% male, with mean age 29±2.8 years. Comparing post- with pre-surveys, retreat attendance was associated with a significant reduction in mean Perceived Stress (12.7 vs 16.3; 95% CI 2.1-5.3) and significant increase in Brief Resilience (3.9 vs 3.7; 95% CI 0.05-0.34) and Cohesion (33 vs 27; 95% CI 4.3-6.7). First year residents experienced the greatest increase in Cohesion compared to fourth year residents (p<0.001). Pre-retreat cohesion was significantly lower in 2022 than in 2018-2019 (26.6 vs 28.7 vs 28.6; p=0.04), with stress and resilience not significantly different by year. An annual resident retreat decreased stress, while increasing resilience and cohesion within a radiology residency, supporting retreats as a potentially viable intervention to promote physician well-being.

Assessing the debt and current state of financial literacy in a cohort of diagnostic & interventional radiology residents

Rationale and objectivesThe purpose of this study is to assess diagnostic and interventional radiology resident physicians' knowledge of core facets of financial literacy: loans, real estate, investments and retirement, and insurance, with the goal of determining the need for formal financial literacy education within radiology residency programs. MethodsFrom May 2021 to March 2022, surveys were sent to 196 diagnostic and 90 interventional radiology residency programs. Residents were asked 10 knowledge multiple choice questions to assess areas of financial literacy. Custom R programming was used to evaluate responses. ResultsA total of 149 diagnostic radiology residents and 49 interventional radiology residents responded to portions of the survey, for a total of 198 respondents. Of the cohort with demographic data collected, 84 out of 141 residents (60 %) had over $100,000 of debt following medical school graduation, with 115 out of 146 DR residents (79 %) and 41 out of 47 (87 %) IR residents reporting no coursework in finance. ConclusionsMany radiology resident physicians have a significant debt burden, no official financial education, and clear knowledge gaps in areas of financial literacy. A structured financial education curriculum could better prepare residents for the financial realities of post-residency life.

Wellness Among Interventional Radiologists: Results From a Multidimensional Survey

To evaluate wellness among interventional radiologists using a multidimensional survey. An anonymous 53-item survey, including 36 Perceived Wellness Survey (PWS) prompts, was created in Qualtrics (an online survey tool) to assess wellness among interventional radiology attendings and residents. The survey was open from June toSeptember, 2022, 2 years into the COVID-19 Pandemic. The survey was distributed via Society of Interventional Radiology Forums, social media (Twitter, LinkedIn, and Facebook), and personal correspondence. PWS scores were categorized into Wellness Composite and subscores (physical, emotional, intellectual, psychological, social, and spiritual). 367 surveys were completed. 300 (81.7%) respondents were male and 67 (18.3%) were female. Respondents included attending physicians (297; 81.0%) and residents (70; 19.0%). Practice settings included academic (174; 47.4%), private (114; 31.0%), private-academic hybrid (62; 16.9%), and others (17; 4.7%). Mean Wellness Composite at academic centers (14.74±3.16; range: 5.42-23.50) was significantly lower than at private (15.22±3.37; range: 6.13-23.51) and hybrid (16.14±2.47; range: 10.20-23.50) practices (p=0.01). Respondents <40 years old had significantly lower emotional wellness subscores compared to those ≥40 years old (4.34±0.86 vs. 4.60±0.87; p=0.006). There were no significant differences between geographic regions in the United States, however, International respondents had significantly lower social and intellectual wellness (INT) subscores. Physical wellness subscore (4.00±0.9) was significantly lower than the other subscores (4.59±0.81) (p<.001). Overall mean Wellness Composite was 15.11±3.13 (range: 5.42-23.51). Overall self-reported wellness was lower among interventional radiologists practicing at academic centers. Interventional Radiologists <40 years old and residents had lower emotional wellness, while international respondents had lower social and INT. Overall wellness scores were lower than prior PWS studies.

Why Medical Students Pursue Radiology: A Current Longitudinal Survey on Motivations and Controversial Issues in Radiology

Radiology is an increasingly competitive specialty. Various current factors influence medical students' decision to pursue a radiology career, including artificial intelligence (AI), remote reading, and COVID-19. This study seeks to determine the decision-making factors of all alumni from our medical school who matched into a radiology residency, and to gather opinions on emerging radiology topics. A survey querying decision-making factors and opinions on current radiology topics was distributed to all alumni from our medical school (first graduating class in 2011) who previously matched into a diagnostic or interventional radiology residency program (n=57). Wilcoxon Rank-Sum and Fisher's Exact tests were used to determine statistical significance. Forty-three of fifty-seven responses were received (75% response rate). The most influential factor that sparked respondents' interest in radiology was a radiology elective (25/43, 58%). Students who will finish radiology training in 2023 or later were more likely to be influenced by a mentor (15/23, 65%) than those who finished radiology training before 2023 (5/20, 25%) (p=0.04). Respondents reported a 1.6/5 concern about AI negatively impacting their future career in radiology. There was 1.7/5 concern about performing radiology procedures on patients during the COVID-19 pandemic. Respondents predicted that remote reading would have a 3.2/5 positive impact on helping them achieve their preferred lifestyle. Job satisfaction among attending radiologists is rated at 4.3/5. Radiology electives had the greatest influence in piquing students' interest in radiology, while mentorship is assuming increasing influence. AI is perceived as a relatively minimal threat to negatively impact radiologists' jobs. Respondents had little concern about performing radiology procedures during the COVID-19 pandemic. Remote reading is viewed as having a moderately positive impact on lifestyle. Responding radiologists enjoy notably high job satisfaction.

Worldwide Knowledge About Interventional Radiology Among Medical Students: Findings of a Comprehensive Review.

The objective of this comprehensive review is to investigate the studies assessing the interventional radiology knowledge among medical students worldwide and inspect the feasible solutions for improving their perspective on this specialty. A comprehensive literature search was accomplished on PubMed, Scopus, Web of science, and Embase databases. The quality of eligible articles was assessed with the QATSDD assessment tool. After screening of articles, 29 studies were included. All the included articles were published between 2009 and 2021, with 20 studies performed in 2017 and thereafter. Interventional radiologists' duties, procedures, and training pathways were the main subjects investigated in surveys. The interest and exposure to interventional radiology were also assessed. All the studies indicated that the knowledge about interventional radiology compared with other specialties is weak. In 14 studies, over 50% of participants reported their interventional radiology knowledge as either poor or none. The most reason for not considering interventional radiology residency was lack of awareness during medical schools. Studies which held a tutorial course reported the students' awareness and interest improved significantly after the course. The present evidence indicates that although the current awareness of interventional radiology is low, timely didactic courses in medical schools can improve this condition significantly, lead to graduation of more oriented referring physicians, and also attract more fit applicants to interventional radiology residency programs.

The First Virtual Integrated Interventional Radiology Residency Application Experience During COVID-19: 2020-2021 Survey of Integrated IR/DR Applicants and Program Directors

PurposeThis study aims to characterize the experiences of integrated IR/DR applicants and program directors (PDs) participating in the first completely virtual application process during the COVID-19 pandemic. MethodsSurvey questionnaires were distributed to IR/DR applicants and PDs for the 2020-2021 application cycle. Applicants were asked questions regarding social media presence, number of interviews received, preference of the in-person interview process, and descriptive experiences of the process. PDs were surveyed regarding social media presence, applications received, and interview and match results during the virtual 2020-2021 cycle and the in-person 2019-2020 cycle. Results56 (25.3 %) applicants responded to the survey. 44 (78.6 %) students relied on social media to learn about programs. 33 students (58.9 %) applied to more programs than they had planned. Students applied to an average of 47.5 integrated IR/DR programs and 48.8 DR programs and received an average of 18.8 and 17.8 IR and DR interviews, respectively. 98.2 % of students reported “convenience” and “ease and flexibility of interview scheduling” as advantages of virtual interviews. Sixteen PDs (17.3 %) completed the survey. 15 PDs (93.8 %) created a program-specific promotional video. Compared to 172 applications received in the 2019-2020 season, residency programs received 151 this past cycle (p = .24). A similar number of applicants were interviewed and ranked in both cycles. ConclusionMedical students created social media accounts and applied to more programs, and overall preferred virtual interviews. There was no significant change in the number of interview invites or the number of ranks submitted by PDs.

Virtual reality simulation training in stroke thrombectomy centers with limited patient volume-Simulator performance and patient outcome.

Virtual reality simulation training may improve the technical skills of interventional radiologists when establishing endovascular thrombectomy at limited-volume stroke centers. The aim of this study was to investigate whether the technical thrombectomy performance of interventional radiologists improved after a defined virtual reality simulator training period. As part of the quality surveillance of clinical practice, we also assessed patient outcomes and thrombectomy quality indicators at the participating centers. Interventional radiologists and radiology residents from three thrombectomy-capable stroke centers participated in a five months thrombectomy skill-training curriculum on a virtual reality simulator. The simulator automatically registered procedure time, the number of predefined steps that were correctly executed, handling errors, contrast volume, fluoroscopy time, and radiation dose exposure. The design was a before-after study. Two simulated thrombectomy cases were used as pretest and posttest cases, while seven other cases were used for training. Utilizing the Norwegian Stroke Register, we investigated clinical results in thrombectomy during the study period. Nineteen interventional radiologists and radiology residents participated in the study. The improvement between pretest and posttest cases was statistically significant for all outcome measures in both simulated cases, except for the contrast volume used in one case. Clinical patient outcomes in all three centers were well within the recommendations from multi-society consensus guidelines. Performance on the virtual reality simulator improved after training. Virtual reality simulation may improve the learning curve for interventional radiologists in limited-volume thrombectomy centers. No correlation alleged, the clinical data indicates that the centers studied performed thrombectomy in accordance with guideline-recommended standards.

Two Affordable, High-Fidelity Central Venous Models for Ultrasound-Guided Interventional Training.

Ultrasound-guided vascular access is an increasingly popular technique due to its reduced complication and higher success rates. Commercially bought training phantoms allow providers to develop tactile skills in a low-risk setting, but are also expensive and poorly accessible. This study analyzes the efficacy of homemade, low-cost, gelatin-based central line vascular models to teach vascular anatomy and intravascular access techniques in training physicians. A gelatin mold was created using a mixture of unflavored gelatin, hot water, psyllium husk powder, and rubbing alcohol. Latex tubing, balloons, precooked hot dog, and tofu were inserted to simulate arteries, veins, nerves, and the sternocleidomastoid muscle, respectively. Medical students from a single institution participated in a 90-minute workshop led by interventional radiology residents. Participants completed presurveys and postsurveys that assessed knowledge acquisition and confidence levels related to acquiring central access. All images were obtained using a USB-C Butterfly iQ probe. Twenty medical students were analyzed after the workshop. There was a statistically significant increase in self-reported confidence in basic ultrasound use (adjusting gain, depth, probe manipulation), localizing major anatomical structures, using ultrasound for vessel access, and reported ease in identifying muscle, nerves, and major blood vessels under ultrasound. There was also a significant increase in correctly identified anatomical landmarks after the workshop, including the sternocleidomastoid muscle, internal jugular vein, carotid artery, femoral nerve, femoral artery, and femoral vein. Our findings suggest that our homemade, low-cost, gelatin-based models were effective in teaching vascular anatomy and ultrasound-guided vascular access techniques to training physicians.

A 5-Year Update on the IR Residency Match: 2022 National Survey Results of Program Directors and Matched Applicants Compared with 2017

PurposeTo characterize the experiences of matched applicants (MAs) and program directors (PDs) in the 2022 interventional radiology (IR) residency Match and compare with 2017 data. MethodsSurveys were distributed to IR PDs and MAs from the 2022 Match. Findings were compared with those of 2017 using the 2-sample t test and Fisher exact test. ResultsIn total, 68 MAs (40%) and 47 PDs (52%) responded. Collected demographic traits were similar, including ongoing male predominance (77% of MAs, 83% of PDs). Moreover, 86% of MAs and 87% of PDs were “satisfied” with Match outcomes. Compared with those in 2017, MAs applied to more IR programs (P < .001). MAs reported more research (P = .003) and abstracts/publications (P < .001) and ranked these as more important than PDs did (P < .001 for both). Approximately 82% of PDs gave special attention to candidates who completed a visiting rotation at their institution; 60% of MAs and 95% of PDs believed virtual interviews resulted in overinterviewing (P < .001); both agreed they provided convenience and accessibility. Furthermore, 63% of MAs believed a Step 1 pass/fail system will be less equitable for applicants. Additional data on demographics, medical school experiences, applications, interviews, intern year, and rank process were reported. ConclusionsSatisfaction with Match results remained high from 2017 to 2022, although efforts are needed to improve applicants’ ability to navigate the application process, address overapplying, and evaluate concerns regarding the Step 1 pass/fail system. These survey findings will help inform applicants and PDs for future match cycles.

The Gender Gap in Interventional Radiology: Barriers, Opportunities, and the Role of the Integrated IR Residency

To review the gender gap in Interventional Radiology (IR) and explore the role of the Integrated IR residency. A retrospective review of gender demographic data of medical school applicants to Integrated IR residency from 2016-2021, and active residents/fellows ("trainees") in IR and peer specialties from 2007 to 2021. Women comprised 21.0% of medical student applicants to the Integrated IR residency in the 2020-21 academic year, versus 12.9% of Diagnostic Radiology (DR) resident applicants to the Independent IR residency; these figures have stayed relatively constant since 2016-17 and represent a statistically significantly difference (p=0.000044). The Integrated pathway has become the dominant source of IR trainees, growing from 4.4% in 2016-17 to 76.3% in 2020-21 (p=0.0013). From 2007 to 2021, the percentage of all IR trainees who were female grew from 10.5% to 20.3% (p=0.005). From 2017 to 2021, the percentage of Integrated IR residents who were female grew from 13.3% to 22.0% (p=0.053, 19.1% year-over-year growth), and has been higher than the percentage of female Independent IR residents (p=0.048). Women continue to be underrepresented in IR, though this gender gap is improving. The Integrated IR residency appears to have majorly contributed to this improvement, consistently supplying more women into the IR pipeline than through the fellowship/Independent IR residency. Women are significantly better represented among current Integrated IR residents than Independent residents. The now-dominant Integrated IR pathway must increase women recruitment for continued gender gap improvement.

Abstract No. 522 The Impact of Virtual Residency Interviews on the Geographic Distribution of Integrated Interventional and Diagnostic Radiology Residency Matches

Abstract No. 522 The Impact of Virtual Residency Interviews on the Geographic Distribution of Integrated Interventional and Diagnostic Radiology Residency Matches

Abstract No. 102 Using Representation Quotients to Examine Trends in Representation of Racial/Ethnic and Gender Groups Applying and Matriculating into Interventional Radiology Residency Programs Between 2017 and 2021

Abstract No. 102 Using Representation Quotients to Examine Trends in Representation of Racial/Ethnic and Gender Groups Applying and Matriculating into Interventional Radiology Residency Programs Between 2017 and 2021

Results of the 2020 Survey of the American Alliance of Academic Chief Residents in Radiology

Rationale and objectivesAn annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2020 A3CR2 chief resident survey. Materials and methodsAn online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education–accredited radiology residencies. Questions were designed to gather information about residency program practices, benefits, fellowship or advanced interventional radiology (IR) training choices, and the integration of IR training. Subsets of questions focused on the perception of corporatization, non-physician providers (NPPs), and artificial intelligence (AI) in radiology and their relationship to the radiology job market. Results174 individual responses from 94 programs were provided, yielding a 48 % program response rate. Extended emergency department coverage has steadily decreased over the last 5 years (2016–2020), however only 52 % of programs have independent overnight call (without attending coverage). Regarding the impact of new integrated IR residencies on training, 42 % indicated there was no appreciable impact on their DR or IR training, while 20 % indicated DR training for IR residents suffered and 19 % indicated IR training for DR residents suffered. Corporatization in radiology was perceived as the biggest potential threat to the future job market. ConclusionsIntegration of IR residency did not detrimentally affect DR or IR training in most programs. Radiology resident perception of corporatization, NPPs, and AI may help residency programs shape educational content.

Diagnostic & interventional radiology residency program directors' perspectives on the USMLE step 1 exam shift to pass/fail scoring

Rationale and objectivesAs of January 2022, Step 1 of the United States Medical Licensing Examination (USMLE) has changed to pass/fail grading. The purpose of this study was to share survey results and communicate changes Diagnostic (DR) and integrated Interventional (IR) Radiology residency program directors (PDs) will make and aspire to make, given this change. Materials and methodsAn online survey was sent to DR and IR PDs. Data was collected over four months. Custom R programming and MATLAB language scripts were used to evaluate the survey responses. Chi squared tests were used to determine statistical significance for multiple choice questions regarding PD views of Step 1 transitioning to pass-fail. Paired t-tests were used to differentiate pre- and post-values for questions in which PDs ranked criteria for resident selection. ResultsAfter USMLE Step 1 becomes pass/fail, most respondents will use Step 2 CK scores as a more important factor than previously, believe medical schools should share National Board of Medical Examiners (NBME) shelf exam scores, do not believe students will be better prepared clinically, and believe a student's medical school rank will be considered more. ConclusionThe added emphasis on Step 2 CK scores, NBME shelf exam scores, class rank, and a student's medical institution may negate the positive impacts of changing Step 1 to pass/fail. Alternatively, it may present an opportunity for programs to evaluate students more broadly.

Are Standardized Video Interviews Useful for Selecting Integrated Interventional Radiology Residents?

The objective of this project is to evaluate the usefulness of the asynchronous or standardized video interview (SVI) for selecting integrated interventional radiology residents. All selected interviewees were asked to provide a brief recorded video answering 2 standardized questions. The applicants were interviewed in the virtual real-time format by 8 interviewers and ranked by group consensus. The SVIs were independently reviewed by a separate group of 4 interviewers and ranked by group consensus. These consensus ranks were compared to each other to determine similarities and differences in rank order. The results show that the SVIs are not statistically reliable as compared to the real-time interviews. There was a trend for an agreement for the lowest tiers in ranking; however, this was not statistically significant. The asynchronous interview is not equivalent to the virtual real-time interview and would not represent an equivalent replacement. However, the SVI may be useful for screening applicants to interview.

Critical Comparison of the Quality and Content of Integrated Vascular Surgery, Thoracic Surgery, and Interventional Radiology Residency Training Program Websites: Qualitative Study.

BackgroundWith the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery, and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program.ObjectiveThe aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs.MethodsA list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) database. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software.ResultsOf ACGME-accredited programs, 56 of 61 (92%) vascular surgery, 27 of 27 (100%) thoracic surgery, and 74 of 85 (87%) interventional radiology programs had functional websites (P=.12). Vascular surgery websites contained a median of 26 (IQR 20-32) content items, thoracic surgery websites contained a median of 27 (IQR 21-32) content items, and interventional radiology websites contained a median of 23 (IQR 18-27) content items. Two content items considered highly influential to applicant program decisions are procedural experience and faculty mentorship, which were reported at 32% (18/56) and 11% (6/56) for vascular surgery, 19% (5/27) and 11% (3/27) for thoracic surgery, and 50% (37/74) and 15% (11/74) for interventional radiology (P=.008 and P=.75), respectively. Key deficits were work hours, debt management, and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; and operative experiences and the program director’s contact and message for thoracic surgery. Interventional radiology deficits were work hours, and thoracic surgery deficits were procedural experience. Both interventional radiology and thoracic surgery websites lacked information on evaluation criteria and faculty mentorship.ConclusionsThis study has uncovered key differences in the availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content to attract valuable candidates.

Abstract No. 289 Network analysis of the 2016-2021 interventional radiology residency match: algorithmic identification of dynamic communities and influencers

Interventional radiology (IR) residency grew from 7 programs and 15 positions in 2016 to 87 programs and 164 positions in 2021. Analysis of prior years’ match data can reveal the most well-connected schools and programs, communities, influencers that bridge communities, and the network’s evolution over time. Applicants to IR and residency program stakeholders will gain valuable insights from analysis of the IR training network.

Abstract No. 288 The impact of the new interventional radiology residency program on the entrance of women into the field

The number of women entering the field of interventional radiology (IR) has historically lagged behind other surgically oriented specialties such as general and orthopedic surgeries. This study aims to determine if the creation of the new IR residency in 2016 has increased female recruitment into IR.

Abstract No. 286 Variance of information standardization between integrated interventional radiology and neurosurgery residency program websites

The residency match process has changed dramatically with the advent of virtual interviews. Residency websites have played a greater role in informing student applicants of the program. The aim of this study is to compare the content and standardization of Integrated interventional radiology (IR) program websites with those of neurosurgery (NS), a longer-standing specialty.

Abstract No. 526 How do interventional radiology residency program directors prefer to increase female and under-represented minority (URM) representation?

Abstract No. 526 How do interventional radiology residency program directors prefer to increase female and under-represented minority (URM) representation?