Radiology Residency Program Directors Research Articles

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.

Current Perception of Diversity in Academic Radiology: A Mixed Methods Study of Radiology Program Directors

To assess the perceived state of diversity in Radiology Residency Programs in the United States and to evaluate the level of acceptance for diversity, equity, and inclusion (DEI) initiatives. An electronic survey was conducted of the Radiology Residency Programs in the United States in December 2021 and January 2022. Respondents were recruited by email sent to the members of the Association of University Radiologists who were Radiology Residency Program Directors. Quantitative and Qualitative analyses were performed. Of the 198 emails sent out to the Radiology Program Directors, 53 completed surveys were returned (response rate of 27%). Although some progress has been made in increasing the number of women and Asians in Academic Radiology, there is persisting imbalance of the numbers of African American and Latinx radiologists which comprise far less than 25% of the physician workforce. Nearly half of the respondents reported having a Vice Chair of DEI. Three themes emerged from the qualitative analysis. Most respondents agreed that diversity should be considered when recruiting faculty and residents. Many noted a strong commitment to DEI but they felt there was room for improvement in formalizing efforts to aid in recruitment of underrepresented minorities. Diversity education was more likely mandatory for residents and optional for faculty. Academic Radiology programs are recognizing the value of internal DEI leadership roles. Radiologists are implementing DEI initiatives and making intentional changes in the recruitment of diverse radiologists. More concerted efforts are needed to increase the low numbers of African American and Latinx radiologists. Effective evaluation metrics for various DEI programs are needed to assess how successful these endeavors are in creating lasting changes.

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?

Views of Diagnostic Radiology Residency Program Directors Regarding Methods to Increase Female and Under-Represented in Medicine Residents: A Cross-sectional Study

Diagnostic radiology remains one of the least diverse medical specialties. Recent reports have found that the number of female and under-represented in medicine (URiM) residents have not increased despite efforts to increase representation over the last decade. Given the critical role of residency program directors in selecting diverse applicants, this study was performed to identify which strategies were most preferred to increase the number of female and/or URiM residents by directors of diagnostic radiology residency training programs. This was an anonymous, cross-sectional study of diagnostic radiology residency program directors that included a survey about program characteristics, demographics, and strategies to increase the number of female and/or URiM residents. The questionnaire was submitted to 181 potential participants with a 19.9% response rate. The most preferred strategies to increase diversity involved directly recruiting medical students, promoting mentorship, increasing the number of diverse teaching faculty, and unconscious bias training. The least supported strategies included deemphasizing exam scores, accepting more international graduates, accepting a minimum number of female and/or URiM applicants, and de-identifying applications. Female and/or URiM program directors indicated a statistically significant preference for medical student recruitment and providing an opportunity to discuss workplace issues for female and/or URiM trainees (p < 0.05). Diagnostic radiology residency program directors endorsed a wide variety of strategies to increase diversity. Recruitment of female and/or URiM medical students and promoting the number of diverse faculty members and mentorship of trainees by these faculty appear to be the most preferred strategies to increase female and/or URiM residents. Female and/or URiM program directors placed a greater importance on recruiting diverse applicants and supporting safe discussion of workplace issues faced by female and/or URiM radiology residents.

Potential Impact of a Pass or Fail United States Medical Licensing Exam Step 1 Scoring System on Radiology Residency Applications

To assess the anticipated impact of the change in United States Medical Licensing Examination Step 1 scoring from numerical to pass or fail on the future selection of radiology residents. An anonymous electronic 14-item survey was distributed to 308 members of the Association of Program Directors in Radiology and included questions regarding the anticipated importance of various application metrics when Step 1 becomes pass or fail. Secondary analyses compared responses based on the current use of a Step 1 scoring screen. Eighty eight respondents (28.6% [88/308]) completed the survey. Most (64% [56/88]) noted that the United States Medical Licensing Examination Step 2 Clinical Knowledge (CK) score will likely be one of the top three most important factors in assessing applicants, followed by class ranking or quartile (51% [45/88]) and the Medical Student Performance Evaluation/Dean's Letter (42% [37/88]). Over 90% (82/88) of respondents anticipate potentially or definitively requiring Step 2 CK scores before application review, and 50% (44/88) of respondents anticipate extending interview invites at a later date to receive Step 2 CK scores. These results did not significantly differ between programs who currently use a Step 1 scoring screen and those who do not. As Step 1 transitions from a numerical score to pass or fail, radiology residency program directors will likely rely on Step 2 CK scores as an objective and standardized metric to screen applicants. Further investigation is needed to identify other objective metrics to evaluate applicants before Step 1 becomes pass or fail.

Physics Teaching of Radiology Residents: How Much Is Too Much?

At the beginning of each academic year, you may hear “complaints” from some diagnostic medical physicists who struggle to get more physics teaching time. Their efforts should be appreciated. Looking from the other side, radiology faculty members and residency program directors may also wonder, “How many time slots should be allocated for physics teaching?” To date, there is no clear answer, and to our knowledge, the answer still depends on individual programs and/or departments according to their perceptions of the value of physics teaching.

Descriptive analysis of interventional radiology residency program directors in the United States

PurposeTo analyze the academic background, demographics and scholarly metrics of Interventional Radiology (IR) residency program directors (PDs) in the United States. MethodsOnline search of publicly available resources was performed from April 6–10, 2020. PDs and associate PDs of ACGME accredited integrated and independent IR residency programs were included in the study. The variables collected from publicly available sources included age, sex, academic background (including medical school, residency and fellowship), and scholarly activity (publications, citations and h-index). Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. ResultsA total of 174 PDs and associate PDs from 110 unique integrated and independent IR residency programs were included in the study. One hundred fifty three (87.9%) were male and twenty one (12.1%) were female. The average age of PDs was 47.39 years (SD 8.99, median 45, range 34–74). Eighty six percent of the PDs were American medical school graduates, 97% received a MD degree or foreign equivalent, and 3% received a DO degree. There was no statistical difference between male and female PDs with regards to number of publications, average number of citations or mean h-index. Fellow of the Society of Interventional Radiology (FSIR) qualification was held by 21.3% and PDs with FSIR designation had significantly higher scholarly metrics. ConclusionIR Residency PDs are predominantly male and graduates of American medical schools. Women represent only 12% of the IR PD workforce with no significant difference in scholarly metrics of female PDs compared to male PDs. PDs with FSIR designation had significantly higher scholarly metrics.

Diagnostic Radiology Residency Program Director Workforce in the United States: A Descriptive Analysis

To investigate and describe the demographics, academic background, and scholarly activity of Diagnostic Radiology (DR) residency program directors in the United States. A list of all DR residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and corresponding program directors (PD) was obtained from ACGME website. Information about each PD was obtained from publicly available sources including program websites, Healthgrades and Doximity. Demographic and academic data including age, sex, educational background, subspecialty, tenure, interval between residency completion and appointment as PD, terms served, additional degrees, academic rank, prior leadership positions and metrics of scholarly activity were recorded. Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. Results are considered statistically significant at p < 0.05. A total of 197 PDs were included in the study of which 139 (70.6%) were male. Average age of PDs was 47.56 years (SD 8.29, median 45, range 35-77). There was no significant difference in median age of male vs female PDs (45 vs 44.5, p = 0.655). Majority of PDs attended American medical schools (181/197, 91.9%), and 16/197 attended international medical schools. Nine PDs received DO degrees (9/197, 4.6%). Academic rank was available for 137 PDs, of which 4 (2.9%) were instructors, 63 (46.0%) were assistant professors, 47 (34.3%) were associate professors and 23 (16.8%) were professors. Fellowship information was available for 183 PDs, of which the most common subspecialties were neuroradiology (24.5%), musculoskeletal radiology (15.8%), abdominal radiology (10.3%), and interventional radiology (9.8%). Female PDs had a significantly higher median publications (13.5 vs 6.0, p = 0.003), median citations (133 vs 37, p = 0.19) and median h-index compared to male PDs (6 ± 3, p = 0.005). Radiology PDs are mostly males who graduated from US allopathic medical schools. Female PDs had significantly higher scholarly metrics compared to male PDs. Twenty three percent PDs were appointed in the last 1 year.

Parental Leave Policy in Radiology Residency Programs: Current Status.

To explore the current status and determine the uniformity of parental leave policies among US radiology residency programs. An electronic survey was developed and sent to 222 radiology residency program directors (PDs) in June 2019 to assess their policies and attitudes toward parental leave. The survey was administered via the Internet Qualtrics Research Suite (Qualtrics, Provo, Utah) format with four reminders sent over the course of 2 months before closing the data collection. In all, 74 PDs responded to the survey. Of those, 88% claimed to have a maternal leave policy (88% explicitly written and 77% paid); 80% had a paternal leave policy (88% explicitly written and 75% paid). The average length of maternal and paternal leaves was 7.4 ± 3.9 and 3.7 ± 3.7 weeks, respectively. Parental leaves were allocated at least every other year in over 70% of programs. Approximately 60% of the PDs required residents to make up call rotations for parental leaves. About 92% of responsive programs adjusted angiography and fluoroscopy rotations for trainees throughout the pregnancy or according to the trainee's request. Policies did not generally address issues of breastfeeding and nontraditional parenthood. The proportion of radiology programs with explicit maternal leave policies remained constant compared with previous surveys during the last two decades. However, there was a dramatic rise in the adoption of paternal leave policies. Overall, there was a lack of national uniformity in radiology residency programs' policies concerning parental leave, leaving open the possibility of national guidance in addressing the issue.

Global Radiology Training Prevalence Among Radiology Residency Programs

ObjectiveGlobal Radiology aims to enhance access to medical imaging services and education, worldwide. To date, few reports have evaluated Global Radiology Training (GRT) in radiology residency programs. Here, we examined how radiology residency programs perceive and incorporate GRT into their curriculum, and how this information is promoted online. MethodsTwo methods were used to examine the current state of GRT. First, radiology residency program directors (identified via the Association of Program Directors in Radiology) were surveyed on topics including: Electives, institutional partnerships, resident and faculty involvement, inquiry by prospective residents, and barriers to implementation. Second, radiology residency program websites (n = 193) were examined for existing GRT on the programs’ publicly available webpages. ResultsThere were 62 survey responses (response rate of 19%). Thirty-eight percent (24/62) of residency programs offered a Global Radiology elective to their residents within the past academic year and 27% (17/62) of programs have active affiliations with medical institutions outside of the United States. Eighty-four percent of program directors (52/62) received questions from residency applicants regarding opportunities to participate in Global Radiology. Furthermore, only 13% (26/193) of all radiology residency programs listed at least one GRT elective on their webpage. DiscussionGRT in radiology residency is more widely available than previously reported and has been underrepresented on residency program websites. In the present survey, the majority of radiology residency program directors reported that radiology is an important component of Global Health, one-third of whom have already incorporated the subject into their curriculum. However, most common barriers to GRT include, perceived lack of time in the curriculum and lack of faculty interest. The high prevalence of inquiry from residency program applicants about GRT suggests that it may be a notable factor for applicants during the ranking process. Programs build up GRT may choose to share related information seeking to may choose to emphasize work in Global Radiology on their program webpages.

Diagnostic Radiology Resident Recruitment Part II: Advice to Applicants From Vice Chairs for Education

Applicants to diagnostic radiology residencies often obtain advice regarding the process, typically from local individuals. Materials available on the Internet contribute to this process as well. We are a group of current and former Diagnostic Radiology Residency Program Directors and current Vice Chairs for Education who commonly advise medical students, including regarding radiology as a career. This work is meant to provide a "plain talk" resource for those considering a career in radiology via a radiology residency, written from the point of view of an advisor with lots of experience.

Diagnostic Radiology Resident Recruitment Part I: Advice to Programs (and Program Directors) From Vice Chairs for Education

To the best of our knowledge, there is little available organized advice for diagnostic radiology residency program directors and their programs regarding resident recruitment. We are a group of current and former program directors who are current vice chairs for education and continue to advise and to mentor many educators. We have constructed this article along the yearly schedule of trainee recruitment, including an application review, interviews, and troublesome trends that we have observed.

Contrast reaction training in US radiology residencies: a COARDRI study

ObjectiveTo perform a survey-based assessment of current contrast reaction training in US diagnostic radiology residency programs. MethodsAn electronic survey was distributed to radiology residency program directors from 9/2015–11/2015. Results25.7% of programs responded. 95.7% of those who responded provide contrast reaction management training. 89.4% provide didactic lectures (occurring yearly in 71.4%). 37.8% provide hands-on simulation training (occurring yearly in 82.3%; attended by both faculty and trainees in 52.9%). ConclusionWide variability in contrast reaction education in US diagnostic radiology residency programs reveals an opportunity to develop and implement a national curriculum.

Radiology Resident' Satisfaction With Their Training and Education in the United States: Effect of Program Directors, Teaching Faculty, and Other Factors on Program Success.

Radiology residency education must evolve to meet the growing demands of radiology training. Resident opinions are a major resource to identify needs. However, few published data are available on a national level investigating the radiology resident perspective on factors that influence the resident experience. Our study investigates factors that affect residents' satisfaction with their residency experience and education. A 67-item survey was sent to all radiology residency program directors and coordinators in the United States to be distributed at their discretion. Questions were multiple choice, free-text answer, or 5-point Likert scale. Statistical significance (p < 0.05) was determined using chi-square test, t test, and logistic regression analysis, respectively. Two hundred seventeen radiology residents responded to the survey (range, 212-217 responses per question). Overall, 77.8% (168/216) of residents were satisfied with their residency programs. Subcategories that showed a statistically significant correlation with overall satisfaction, in decreasing strength according to the odds ratio (OR), include the program director or administrative office (OR, 72.2; 95% CI, 27.4-221.9), the daily workstation experience (OR, 30.5; 95% CI, 12.8-80.9), the faculty (OR, 19.5; 95% CI, 8.9-45.4), educational conferences (OR, 7.9; 95% CI, 3.9-16.4), work hours (OR, 6.4; 95% CI, 3.2-13.2), teaching opportunities (OR, 6.5; 95% CI, 3.1-13.8), research opportunities (OR, 5.1; 95% CI, 2.6-10.6), personal study (OR, 2.1; 95% CI, 1.1-4.1), and compensation (OR, 1.9; 95% CI, 1.0-3.7). Our study provides incremental data to the existing literature that offers insight into factors that contribute to a successful radiology residency program.

Perceived Barriers to the Use of High-Fidelity Hands-On Simulation Training for Contrast Reaction Management: Why Programs are Not Using It

Although subjective and objective benefits of high-fidelity simulation have been reported in medicine, there has been slow adoption in radiology. The purpose of our study was to identify the perceived barriers in the use of high-fidelity hands-on simulation for contrast reaction management training. An IRB exempt 32 questions online web survey was sent to 179 non-military radiology residency program directors listed in the Fellowship and Residency Electronic Interactive Database Access system (FREIDA). Survey questions included the type of contrast reaction management training, cost, time commitment of residents and faculty, and the reasons for not using simulation training. Responses from the survey were summarized as count (percentage), mean ± standard deviation (SD), or median (range). 84 (47%) of 179 programs responded, of which 88% offered CRM training. Most (72%) conducted the CRM training annually while only 4% conducted it more frequently. Didactic lecture was the most frequently used training modality (97%), followed by HFS (30%) and computer-based simulation (CBS) (19%); 5.5% used both HFS and CBS. Of the 51 programs that offer CRM training but do not use HFS, the most common reason reported was insufficient availability (41%). Other reported reasons included cost (33%), no access to simulation centers (33%), lack of trained faculty (27%) and time constraints (27%). Although high-fidelity hands-on simulation training is the best way to reproduce real-life contrast reaction scenarios, many institutions do not provide this training due to constraints such as cost, lack of access or insufficient availability of simulation labs, and lack of trained faculty. As a specialty, radiology needs to better address these barriers at both an institutional and national level.

Change Overload and the Program Director

An epidemic has swept across radiology. Its principal victims are radiology residency and fellowship program directors. Its symptoms are often vague and nonspecific but include fatigue, disorientation, frustration, and burnout. Most victims report a loss of enthusiasm for their job, and some have become so discouraged that they have resigned. This, in turn, inflicts collateral damage on the programs and trainees for whom they are responsible. We have dubbed this malady change overload.

PACS used while on-call: a national survey of radiology program directors and chief residents.

The aim of this study was to determine the prevalence of different diagnostic image viewing platforms used by radiologists while on-call, and to assess the opinions and preferences of radiology program directors and chief residents regarding their use. An online survey was sent electronically to radiology residency program directors and chief residents via the Association of University Radiologists. Forty-two radiology program directors and 25 chief residents completed the survey, yielding response rates of 24.9 and 8.5 %, respectively. From the survey results, 10 different Picture Archiving Communications Systems (PACS) were identified; GE (25 %), Philips (17 %), and Agfa Impax (15 %) were the most prevalent. Interestingly, only 5 % of all respondents use a secondary "Digital Imaging and Communications in Medicine" viewer for on-call studies. Perceptions of PACS functionality were generally neutral to weakly positive. Most respondents strongly agreed that it is important to have a single integrated PACS for viewing on-call studies and agreed that the PACS should be integrated into the Electronic Medical Records (EMR). The overwhelming majority of respondents use their institution's PACS while on-call. The results show there is still a wide variety of PACS platforms used by different institutions; however, GE, Phillips, and Agfa were some of the most prevalent. Most radiologists surveyed have neutral to slightly positive perceptions about the functionality and ease of use of their PACS. Finally, while radiologists agree that PACS should be integrated with EMR, only 53 % of respondents currently have this arrangement.

The use of ACR Appropriateness Criteria: a survey of radiology residents and program directors

PurposeAssess the utilization of American College of Radiology Appropriateness Criteria (ACR-AC) among radiology residency program directors (PDs) and residents. MethodsRadiology PD and resident survey. ResultsSeventy-four percent (46/62) of PDs promote ACR-AC in education (P<.05), and 84% (317/376) of residents have read at least a few (P<.05). Seventy-four percent (74/100) of first-year residents compared to 56.8% (157/276) of second- to fourth-year residents report at least occasional faculty reference of ACR-AC (P<.05). ACR-AC are well regarded (P<.05), but 40% believe that they are perplexing. ConclusionThere is widespread resident awareness of ACR-AC and integration into resident training. However, faculty are only beginning to teach with them, and radiologists are not citing them with clinicians.

Restriction of ACGME Fellowships to Candidates Completing US and Canadian Accredited Residencies: Level of Support and Expected Consequences

The aim of this study was to determine the level of support for the proposal to restrict ACGME-accredited fellowships to candidates who completed residencies accredited by the ACGME or the Royal College of Physicians and Surgeons of Canada. Perceptions of foreign-trained international medical graduates during and after fellowships were also assessed. An e-mail survey was sent to the members of the organizations that represent academic chairpersons (the Society of Chairs of Academic Radiology Departments) and radiology residency and fellowship program directors (the Association of Program Directors in Radiology) and to the program directors of the largest American radiology subspecialty society (the American Society of Neuroradiology). Results were analyzed separately for each of the 3 societies interviewed and then as a composite report for all 3 societies. Approximately 60% of the respondents said that they have offered at least one fellowship or faculty position to foreign-trained applicants in the past 5 years. More than 70% of the respondents said that these doctors performed equally to or better than American-trained ones both clinically and academically. The majority of members of all 3 societies responding opposed enactment of the rule, with the American Society of Neuroradiology being the most disapproving. The main concerns of those supporting the new rule were the inhomogeneous and sometimes unknown levels of training of the foreign-trained doctors and the need to favor American graduates. Those opposed were mostly worried about diminishing the quality of fellowship candidates, programs being unable to fill their positions, and a decrease in academic-oriented people. Most respondents opposed the proposed rule. The majority were supportive of foreign-trained physicians continuing their training in the United States.

A Survey of Diagnostic Radiology Residency Program Directors and the Increasing Demands of Program Leadership

The aim of this study was to identify trends and opinions with respect to leadership turnover, leadership responsibilities, and residency requirements. Program directors (PDs) of diagnostic radiology (DR) residency programs were identified via the ACGME and the Fellowship and Residency Electronic Interactive Database, along with a programmatic website search. A web-based survey was e-mailed, with questions concerning lengths of time the current and prior PDs held their positions, residency size, amounts of time spent on and lengths of current and past Program Information Forms, and opinions on how the position has changed and how metrics, outcomes, and documentation may be affecting teaching, resident education, and patient care. Thirty-two percent (60 of 186) of US DR residency PDs answered at least 1 of the survey questions. The average length of time the current PDs held their positions was shorter compared with the previous PDs, and it has taken longer and required more pages to complete the current Program Information Forms compared with prior cycles. The majority of respondents felt that the job of PD was harder than 5 years ago and that turnover among PDs is a "current/impending" problem. The majority of respondents felt that time spent on metrics, outcomes, and documentation is taking away from teaching, learning, and taking care of patients. Many DR residency PDs have recognized increased administrative burdens in recent years. Some feel that these increased demands may in part have negative effects on resident education and patient care.