Teaching Radiology Trainees From the Perspective of a Millennial

Implementation of training level-specific self-study guides for diagnostic radiology residents

INTRODUCTION

Currently, there is no universally accepted diagnostic radiology curriculum for self-studying, so diagnostic radiology residents often have a challenging time knowing where to begin their independent studying away from work. In an effort to meet the needs of today's residents, we attempted to provide structured, comprehensive self-studying suggestions in a digestible and personalized format.

MATERIALS AND METHODS

Each radiology division attempted to create an optimal learning resource form for the residents to use for self-studying while on each rotation. Each self-study guide included hyperlinks to easily accessible online resources.

RESULTS

Training level-specific week-by-week recommendations were provided based on the expected types of cases a resident would typically encounter during that timeframe. All of the neuroradiology rotation forms and several of the other subspecialty forms were originally made available to the residents and faculty electronically on July 1, 2022. The forms are now distributed to newly rotating residents on a monthly basis.

DISCUSSION

There is a fine balance between providing residents with comprehensive review material and promoting realistic expectations. In addition, educators must keep in mind financial limitations of their residents and institutions. Learning resources must be affordable to be accessible to all residents. As radiology and technology continuously advance, there will undoubtedly be more and more excellent resources for trainees to learn from. To optimize self-studying, retention of information, and wellness, it is imperative to provide our residents with a structured, personalized, manageable curriculum including easily accessible high-yield resources.

Training the New Radiologists: Approaches for Education

The field of Radiology is continually changing, requiring corresponding evolution in both medical student and resident training to adequately prepare the next generation of radiologists. With advancements in adult education theory and a deeper understanding of perception in imaging interpretation, expert educators are reshaping the training landscape by introducing innovative teaching methods to align with increased workload demands and emerging technologies. These include the use of peer and interdisciplinary teaching, gamification, case repositories, flipped-classroom models, social media, and drawing and comics. This publication aims to investigate these novel approaches and offer persuasive evidence supporting their incorporation into the updated Radiology curriculum.

A Novel Hands-on Approach Towards Teaching Diagnostic Radiology Residents MRI Scanning and Physics

RATIONALE AND OBJECTIVES

Traditional approaches towards teaching magnetic resonance imaging (MRI) scanning and physics have limitations that a hands-on course may help overcome. A dedicated week of MRI instruction may help improve radiology resident confidence and competence. Additional benefits may include improved physician-technologist communication and accelerated mastery of MRI safety.

MATERIALS AND METHODS

Surveys and tests were approved by our Program Evaluation Committee and administered at the beginning and at the end of this one-week course. The course consisted of protected reading time as well as practice scanning with a research magnet and assisting with clinical scanning under the close supervision of a licensed MRI technologist. Eighteen senior residents (nine third-year and nine fourth-year) participated in this course during its first year.

RESULTS

Few residents had previous experience with MRI physics, scanning, or research prior to residency. After this course, mean resident confidence increased by 0.47 points (3.33 vs 2.86; p=0.01) on a five-point Likert scale. Understanding of MRI physics, as measured by pre- and post-tests, increased by 22% (0.72 vs 0.50; p<0.01), corresponding to a large effect size of 1.29 (p<0.001). Resident feedback reported that this course was efficacious (5/5), engaging (4.9/5), and had optimal faculty oversight. The most highly rated component of the course was the opportunity to experiment with the research MR scanner (5/5).

CONCLUSION

A dedicated week of MRI education was highly rated by residents and associated with improvements in confidence and understanding, suggesting a positive correlation between confidence and competence. Additional metrics, such as trends in scores on the American Board of Radiology's Core Examination over the next several years, may further support the apparent benefits of this hands-on MR course.

Responsive Web-based Breast Imaging Core Curriculum for International Radiology Residents with Self-Assessment: A Pilot Study

RATIONALE AND OBJECTIVES

Lack of uniformity in radiology resident education is partially attributable to variable access to subspecialty education. Web-based courses improve standardization, but with growing emphasis on competency based education, more evaluation of their effectiveness is needed. We created a responsive web-based breast imaging curriculum for radiology residents including self-assessment and a satisfaction survey.

MATERIALS AND METHODS

Two global academic institutions collaboratively developed a breast imaging curriculum to address radiology residents' educational needs. This virtual course comprised 11 video lectures, nine didactic (with attached pre-test and post-test assessments) and two case review sessions. In April 2020, this optional curriculum was made available to all 56 radiology residents in one residency program cluster in Singapore, to be accessed alongside the breast imaging rotation as a supplement. A voluntary anonymous satisfaction survey was provided upon completion.

RESULTS

A total of 39 of the 56 radiology residents (70%) completed the course. For the average score of nine lectures (maximum score 5), there was a significant increase in mean pre and post - test scores (mean = 2.2, SD = 0.7), p < 0.001. The proportion of residents with improvement between the pre-test score and the post-test score ranged from 74% to 100% (mean, 84%). Thirty three of the 39 participants (85%) completed the satisfaction survey, and all agreed or strongly agreed that the curriculum increased their knowledge of breast imaging.

CONCLUSION

This web based breast imaging curriculum supplement was viewed positively by participating residents and improved their self-assessed knowledge. Curriculum access could be expanded to improve global radiology education.

Affecting Change: Enhancing Feedback Interactions with Radiology Trainees

Feedback is a critical part of the learning process and is a valuable tool to empower adult learners. Modern feedback theory places the learner at the center of the feedback encounter. Individual and institutional barriers to effective giving and receiving of feedback can be overcome through education and attention to the form and content of feedback. We review the elements of effective feedback and address issues of framing, environmental, and social factors which aid in providing psychological safety and trust, as necessary elements to create a culture of feedback in radiology training programs. We provide practical strategies to empower learners with the necessary skills to solicit, receive, and reflect on feedback.

Improving the Relationship Between Confidence and Competence: Implications for Diagnostic Radiology Training From the Psychology and Medical Literature

The focus of diagnostic radiology training is on creating competent professionals, whereas confidence and its calibration receive less attention. Appropriate confidence is critical for patient care both during and after training. Overconfidence can adversely affect patient care and underconfidence can create excessive costs. We reviewed the psychology and medical literature pertaining to confidence and competence to collect insights and best practices from the psychology and medical literature on confidence and apply them to radiology training. People are rarely accurate in assessments of their own competence. Among physicians, the correlation between perceived abilities and external assessments of those abilities is weak. Overconfidence is more prevalent than underconfidence, particularly at lower levels of competence. On the individual level, confidence can be calibrated to a more appropriate level through efforts to increase competence, including sub-specialization, and by gaining a better understanding of metacognitive processes. With feedback, high-fidelity simulation has the potential to improve both competence and metacognition. On the system level, systems that facilitate access to follow-up imaging, pathology, and clinical outcomes can help close the gap between perceived and actual performance. Appropriate matching of trainee confidence and competence should be a goal of radiology residency and fellowship training to help mitigate the adverse effects of both overconfidence and underconfidence during training and independent practice.

Teaching in Orthopaedic Surgery: Effective Strategies for Educating the Modern Learner in a Modern Surgical Practice

Prioritizing the education of orthopaedic surgery residents and fellows is essential for the future of the field. This review highlights strategies that educators may find useful in improving their teaching skills for the modern orthopaedic surgery learner. Educators may benefit from focusing on active, effortful, and repetitive engagement in lecture; setting clear expectations to help track progress in clinic; and breaking skills into smaller steps in context of a framework when teaching procedural skills. Providing objective assessment and growth-oriented feedback helps establish a close rapport between educator and trainee while encouraging personal development. Through a remediation process that examines deficiency in core areas and equitability of the learning environment, the trainee and the educator may engage in a fair discussion that prevents trainees from falling behind. Finally, in the era of COVID-19, e-learning and virtual simulations have become increasingly used as effective modalities for teaching clinical knowledge and procedures to trainees. The medical education landscape has been changing at a rapid pace, and by evaluating and adapting to the novel educational models of today, the modern orthopaedic surgeon ensures a learning environment that is equitable, effective, and inspiring for the orthopaedic surgeon of tomorrow.

Mentoring in radiology: An asset worth exploring!

Residents experience high pressure to be successful in both their career and in keeping up an optimal work-life balance. With a mentoring program, faculties can alleviate stress and provide help for their residents. It is now well established that mentor-mentee relationships during medical school, have influence in career decisions and professional identity formation. The same can be said for mentor-mentee relationships during radiology residency. In general, universal rules of mentoring are also useful and applicable in the field of radiology. These universal rules for establishing a successful mentoring relationship include creating a relationship of trust and confidentiality, clearly defining roles and responsibilities, establishing short- and long-term goals, using open and supportive communication, and collaboratively solving problems. The institutions and the radiology departments should be well prepared and aware of the responsibility to have trainees, providing time for mentors to dedicate to their academic duties. They have to implement strategies to effective mentor matching and orientation as well as the ability to provide evaluation with qualitative feedback. Periodic assessment should be warranted together with the incorporation of new technology as it plays a critical role in the training of millennial radiologists as they take the profession into a technology-laden future of medical imaging.

How to choose an abdominal imaging fellowship

Radiologists in training draw from their early experiences in residency when choosing a fellowship. Once they have decided on an abdominal imaging fellowship, applicants must learn to navigate the interview process. During this challenging time, applicants explore the difference in clinical curricula and rotations, meet potential mentors and clinical faculty, consider potential academic interests and projects, and choose what location they would like to train for one year after residency. When in training, fellows undergo the challenge of finding employment while learning new skills and refining their abilities to become a well-rounded radiologist and clinician. This article summarizes key points potential applicants should consider when deciding on an abdominal imaging fellowship, how to prepare for the interview season, and how to plan their fellowship year before fellows take the next step to becoming attendings.

Integrating art museum visits into the radiology curriculum: A program to encourage engagement, observation and analytic skills among millennial learners

Millennial learners have unique educational preferences and expectations, many of which vary significantly from those of their predecessors. To aid in the preparation and training of the next generation of radiologists, we have been exploring a teaching technique using an art observation training workshop to foster engagement of millennial radiology residents to pay closer attention to image detail, clearly state the observations and synthesize the "story" of the patient's condition. Fine tuning these visual skills is crucial as research shows that over 70% of errors in interpreting diagnostic imaging studies are related to visual perception errors.

Social Media in Radiology: Overview and Usefulness of Online Professional #SoMe Profiles

Social media is a ubiquitous part of society and used by many healthcare professionals, including radiologists. This article prepared by the 2019-2020 Radiology Research Alliance Social Media Task Force presents different uses and benefits of an online professional social media profile. Physician and healthcare-specific issues along with popular platforms such as LinkedIn, Facebook, Twitter, Instagram, and YouTube are used to explore topics including education, branding, research, mentorship, promotion, and leadership.

Learning How to Order Imaging Tests and Make Subsequent Clinical Decisions: a Randomized Study of the Effectiveness of a Virtual Learning Environment for Medical Students

RATIONALE AND OBJECTIVES

Two critical skills that medical students must acquire during undergraduate education are the ability to order imaging tests and make clinical decisions based on their results. We implemented an e-learning course in Moodle specifically designed to teach these skills to medical students. The aim of this study was to assess the effectiveness of our course.

MATERIAL AND METHODS

We randomized 26 undergraduate medical students to an experimental group that had access to the virtual learning environment and a control group that did not. Three weeks after the course, we evaluated its effectiveness through a blinded objective structured clinical examination. To avoid any bias in favor of the experimental group, the assessment considered scores on two pre-specified subscales: one related to the contents of the course and the other to new clinical scenarios.

RESULTS

Students that completed the e-course performed better overall than controls (mean score ± standard deviation 59.3 ± 6.2 vs 41.8 ± 10.2, p = 0.0020). This better performance was observed in both types of skills assessed (ordering imaging tests, and making diagnostic and therapeutic decisions based on test results). More importantly, this better performance of the experimental group was observed consistently both with items related to the course content (1.7 times higher, p = 0.0034) and new scenarios (1.3 times higher, p = 0.0098).

CONCLUSIONS

Through an ad - hoc e-course, undergraduate medical students learned effectively how to order imaging tests and make optimal subsequent decisions. Moreover, they were able to apply these skills to new clinical scenarios.

A virtual emergency: learning lessons from remote medical student education during the COVID-19 pandemic

Purpose

The COVID-19 pandemic resulted in the cancelation of traditional on-site clinical rotations for medical students across the country. Radiology educators have had to rapidly adapt to a new, virtual educational landscape. We describe our experience restructuring a Trauma and Emergency Radiology Elective to an online format and present survey data obtained from students who completed the course.

Methods

This elective is a 4-week course offered to third and fourth year medical students at a large Level 1 Trauma Center. Changes to the traditional rotation included assigning an increased number of self-study educational resources, independent review of unknown cases using a virtual workstation, and online interactive conferences. At the conclusion of each block, students were asked to complete post-course feedback surveys.

Results

Thirteen students enrolled in this online course; 92% submitted post-course surveys. Students strongly agreed that the course was clinically relevant, with accessible, engaging material (average score, 4.92/5), and 91.7% of students were very likely to recommend this rotation to others. Students reported improved post-course confidence in ordering and interpreting imaging studies. A majority (60%) of students who had previously taken an on-site course would have preferred a course that combined traditional and online learning elements.

Conclusions

The success of our online rotation highlights the merits of self-directed learning and flipped-classroom techniques. Many of the principles incorporated into this course could be applied and/or modified to increase medical student engagement when students return to the hospital.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10140-020-01874-2.

QR Codes: A Simple Tool for Engaging Radiology Audiences

As the expectations of modern learners change, it is important for educators to adapt. Quick Response codes are an easy way to distribute web-based information to audiences. We familiarize the reader with Quick Response codes and demonstrate a few of the simple ways they can be incorporated into radiology lectures to increase audience engagement including reference dissemination, audience participation, surveys and quizzes.

Providing Effective Feedback in Breast Imaging to Improve Trainee Performance

While feedback is an essential component of medical education, feedback to trainees is frequently nonspecific and not focused on performance improvement. Providing specific feedback to trainees helps them to reflect, develop self-assessment skills, and recalibrate. In light of increasing clinical volumes, stresses related to modern healthcare delivery, and high physician burnout, instructors need efficient methods to provide actionable feedback to trainees. For breast imaging radiologists involved in education, improving feedback skills can help their learners develop expertise in breast imaging while also attracting and inspiring the next generation of radiologists.

Diagnosis in a snap: a pilot study using Snapchat in radiologic didactics

Purpose

To evaluate Snapchat, an image-based social media platform, as a tool for emergency radiologic didactics comparing image interpretation on mobile devices with conventional analysis on a classroom screen.

Materials and methods

Seven radiology residents (4 juniors, 3 seniors;4 males, 3 females; 28.4 years old, ± 1.7 years) were shown 5 emergent radiologic cases using Snapchat and 5 cases of similar content and duration on a classroom projector over 4 weeks. All images depicted diagnoses requiring immediate communication to ordering physicians. Performance was scored 0–2 (0 = complete miss, 1 = major finding, but missed the diagnosis, 2 = correct diagnosis) by two attending radiologists in consensus.

Results

All residents performed better on Snapchat each week. In weeks 1–4, juniors scored 21/40 (52.5%), 23/40 (57.5%), 19/40 (47.5%), and 18/40 (45%) points using Snapchat compared with 13/40 (32.5%), 23/40 (57.5%), 14/40 (35%), and 13/40 (32.5%), respectively, each week by projector, while seniors scored 19/30 (63.3%), 21/30 (70%), 27/30 (90%), and 21/30 (70%) on Snapchat versus 16/30 (53.3%), 19/30 (63.3%), 20/30 (66.7%), and 20/30 (66.7%) on projector. Four-week totals showed juniors scoring 81/160 (50.6%) on Snapchat and 63/160 (39.4%) by projector compared with seniors scoring 88/120 (73.3%) and 75/120 (62.5%), respectively. Performance on Snapchat was statistically, significantly better than via projector during weeks 1 and 3 (p values 0.0019 and 0.0031).

Conclusion

Radiology residents interpreting emergency cases via Snapchat showed higher accuracy compared with using a traditional classroom screen. This pilot study suggests that Snapchat may have a role in the digital radiologic classroom’s evolution.

Benefits of an Escape Room as a Novel Educational Activity for Radiology Residents

RATIONALE AND OBJECTIVES

We created a radiology Escape Room, a competitive game where a team of players must discover clues and solve a mystery to escape a "locked" room. To succeed, players must collaborate and think critically and creatively. Our objectives were to provide a novel team-building activity, teach interesting content about radiology as a specialty, cultivate grit, and share the game with other programs.

MATERIALS AND METHODS

Escape Rooms were held during orientation (BOOT Camp) for incoming radiology residents and for upper level residents and faculty with advanced content (four teams totaling 20 residents and faculty). We repeated the Escape Room 27 times for 144 residents from more than 10 countries at Radiological Society of North America (RSNA) 2018.

RESULTS

Players were engaged and competitive. They were able to connect the activity to their future responsibilities - analyzing knowledge under pressure (being on call), communicating effectively (conveying results and recommendations), having the dexterity and motor skills required for physical puzzles (hand-on procedures), being able to multi-task and come up with differential diagnoses under extreme stress and time pressure (being on call). A post-RSNA survey confirmed satisfaction with the activity, with overall enjoyment receiving the highest rating.

CONCLUSION

It is feasible to create a portable, inexpensive Escape Room as a novel educational platform for radiology residents. Combining knowledge-based challenges and technical skills in a live-action game simulated a real-life situation in which vital patient information must be collected and reported concisely and accurately. A Game Guide is available to program directors and medical educators upon request.

Core curriculum online lecture series in musculoskeletal imaging: initial results

OBJECTIVE

To augment the educational resources available to training programs and trainees in musculoskeletal (MSK) radiology by creating a comprehensive series of Web-based open-access core curriculum lectures.

MATERIALS AND METHODS

Speakers with recognized content and lecturing expertise in MSK radiology were invited to create digitally recorded lecture presentations across a series of 42 core curriculum topics in MSK imaging. Resultant presentation recordings, organized under curriculum subject headings, were archived as open-access video file recordings for online viewing on a dedicated Web page (http://radiologycorelectures.org/msk/). Information regarding the online core curriculum lecture series was distributed to members of the International Skeletal Society, Society of Skeletal Radiology, Society of Chairs of Academic Radiology Departments, and the Association of Program Directors in Radiology. Web page and online lecture utilization data were collected using Google Analytics (Alphabet, Mountain View, CA, USA).

RESULTS

Forty-two lectures, by 38 speakers, were recorded, edited and hosted online. Lectures spanned ACGME curriculum categories of musculoskeletal trauma, arthritis, metabolic diseases, marrow, infection, tumors, imaging of internal derangement of joints, congenital disorders, and orthopedic imaging. Online access to the core curriculum lectures was opened on March 4, 2018. As of January 20, 2019, the core curriculum lectures have had 77,573 page views from 34,977 sessions.

CONCLUSIONS

To date, the MSK core curriculum lecture series lectures have been widely accessed and viewed. It is envisioned that the initial success of the project will serve to promote ongoing content renewal and expansion to the lecture materials over time.

Finding Inspiration for the Next Generation of Breast Radiologists

Challenges currently facing breast radiologists, including controversial screening mammography guidelines, radiologist burnout, and the perceived threat posed by artificial intelligence could deter potential candidates from pursuing a career in radiology. However, breast radiologists play a fulfilling role by decreasing the effect of breast cancer through both early detection and direct interaction with patients and interdisciplinary clinical colleagues. While perception is that artificial intelligence will threaten the need for radiologists, it is more likely that it will improve image interpretation and efficiency in workflow, thereby further improving patient care. Trainees can be engaged in breast imaging through interactive teaching methods and by role modeling clinical and image interpretation skills.

What makes us tick: Implications of personality differences among otolaryngology residents and faculty

OBJECTIVE

The rapid personal and professional growth experienced during medical training and practice is impacted by personality. The surgeon's personality is renowned in both medical lore and literature. However, it is now known that the personality characteristics of today's millennial trainees differ from older faculty. This study investigates the variability of different personality attributes among otolaryngology residents and faculty, as well as the practical implications of these findings.

METHODS

The opportunity to complete a series of web-based, commercially available, self-administered five factor-based personality assessments was given to otolaryngology residents and faculty at nine academic training programs. The psychometrically validated assessments evaluate innate personality 1) strengths, 2) challenges, and 3) motivators/values. Differences between groups in the assessed metrics were evaluated using two-tailed t tests.

RESULTS

Seventy-eight otolaryngology faculty and 104 residents completed all three assessments. Of the assessed metrics, there were several significant differences between residents and faculty (all P < 0.05). Residents scored higher than faculty in the domains of interpersonal sensitivity, sociability, and inquisitiveness. With respect to potential challenges, faculty displayed higher levels of skepticism and reservation. In contrast, residents scored higher in the categories of mischievous and dutiful. As for motivators/values, although both groups were highly motivated by altruism, faculty valued tradition more than residents, whereas residents valued hedonism and affiliation more than faculty.

CONCLUSION

There are notable differences between residents and faculty in multiple domains, with implications for communication, education, and professional development.

LEVEL OF EVIDENCE

3 Laryngoscope, 129:2286-2290, 2019.

A Road Map to Foster Wellness and Engagement in Our Workplace-A Report of the 2018 Summer Intersociety Meeting

The 2018 radiology Intersociety Committee reviewed the current state of stress and burnout in our workplaces and identified approaches for fostering engagement, wellness, and job satisfaction. In addition to emphasizing the importance of personal wellness (the fourth aim of health care), the major focus of the meeting was to identify strategies and themes to mitigate the frequency, manifestations, and impact of stress. Strategies include reducing the stigma of burnout, minimizing isolation through community building and fostering connectivity, utilizing data and benchmarking to guide effectiveness of improvement efforts, resourcing and training "wellness" committees, acknowledging value contributions of team members, and improving efficiency in the workplace. Four themes were identified to prioritize organizational efforts: (1) collecting, analyzing, and benchmarking data; (2) developing effective leadership; (3) building high-functioning teams; and (4) amplifying our voice to increase our influence.