Trainee and Attending Perspectives on Remote Radiology Readouts in the Era of the COVID-19 Pandemic

What Program Directors Think About Resident Education: Results of the 2023 Spring Survey of the Association of Program Directors in Radiology (APDR) Part II

RATIONALE AND OBJECTIVES

The Association of Program Directors in Radiology (APDR) administers an annual survey to assess issues and experiences related to residency program management and education. Response data from the 2023 survey provides insights on the impact of COVID-19 on resident recruitment (Part I) and education (Part II), which can be used to facilitate planning and resource allocation for the evolving needs of programs and their leadership.

MATERIALS AND METHODS

An observational, cross-sectional study of the APDR membership was performed using a web-based survey consisting of 45 questions, 12 of which pertain to resident education in the post-pandemic era and are discussed in Part II of a two-part survey analysis. All active APDR members (n = 393) were invited to participate in the survey.

RESULTS

The response rate was 32% (124 of 393). Results were tallied using Qualtrics software and qualitative responses were tabulated or summarized as comments.

CONCLUSIONS

The primary challenges to resident education are faculty burnout, rising case volumes, and remote instruction. However, most program leaders report that in-person readouts are much more common than remote readouts. The ability to offer both in-person and remote AIRP sessions is viewed positively. Most program leaders require Authorized User certification, although many do not think all residents need it. Assessment of procedural competence varies by the type of procedure and is similar to graduates' self-assessment of competence.

The importance of educational tools and a new software solution for visualizing and quantifying report correction in radiology training

A novel software, DiffTool, was developed in-house to keep track of changes made by board-certified radiologists to preliminary reports created by residents and evaluate its impact on radiological hands-on training. Before (t0) and after (t2-4) the deployment of the software, 18 residents (median age: 29 years; 33% female) completed a standardized questionnaire on professional training. At t2-4 the participants were also requested to respond to three additional questions to evaluate the software. Responses were recorded via a six-point Likert scale ranging from 1 ("strongly agree") to 6 ("strongly disagree"). Prior to the release of the software, 39% (7/18) of the residents strongly agreed with the statement that they manually tracked changes made by board-certified radiologists to each of their radiological reports while 61% were less inclined to agree with that statement. At t2-4, 61% (11/18) stated that they used DiffTool to track differences. Furthermore, we observed an increase from 33% (6/18) to 44% (8/18) of residents who agreed to the statement "I profit from every corrected report". The DiffTool was well accepted among residents with a regular user base of 72% (13/18), while 78% (14/18) considered it a relevant improvement to their training. The results of this study demonstrate the importance of providing a time-efficient way to analyze changes made to preliminary reports as an additive for professional training.

Embracing Remote Academic Radiologists

Over the past two years at our large academic center, we successfully developed a formal remote academic radiologist division - composed of permanent fully remote radiologists across multiple subspecialties, living geographically distant from our institution. In this article, we share our experience implementing a remote radiologist division, review the benefits and challenges of this approach, discuss expectations of academic remote radiologists as clinicians, educators, and scholars, and provide tips for success.

Professionalism Training in the Post-COVID-19 Era

INTRODUCTION

Professionalism is one of the ACGME core competencies for radiology residency training. The COVID-19 pandemic has changed the way resident education and training occurs. The primary objective of this study was to perform a comprehensive systematic review of the literature pertaining to adapting professionalism training in radiology residency to the post-COVID-19 era education landscape.

METHODS

We reviewed English-language medicine and health services literature for research that described professionalism training in radiology residency in the post-COVID-19 era radiology search terms and key words in PubMed/MEDLINE and Scopus/Elsevier. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

The search yielded a total 33 articles. We reviewed the citations and abstracts with the initial search yielding 22 articles (without duplicates). Of these, 10 were excluded based on the criteria set forth in the methods. The remaining unique 12 articles were included for qualitative synthesis.

DISCUSSION

This article should provide radiology educators with the tool they need to effectively education and evaluate radiology residents on professionalism in the post-COVID-19 era.

Results of the 2021-2022 Survey of the American Alliance of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). Special topics surveyed for the 2021-2022 academic year were procedural competency and virtual radiology education in the COVID-19 pandemic. The purpose of this study is to summarize the 2021-2022 A3CR2 chief resident survey.

MATERIALS AND METHODS

An online survey was distributed to chief residents from 197 Accreditation Council on Graduate Medical Education-accredited radiology residency programs. Chief residents responded to questions regarding their individual procedural readiness and attitudes on virtual radiology education. A single chief resident from each residency answered programmatic questions including the use of virtual education, faculty coverage, and fellowship choices among their graduating classes.

RESULTS

We received 110 individual responses from 61 programs, yielding a 31% program response rate. Although the majority (80%) of programs maintained purely in-person attending readout throughout the COVID 19 pandemic, only 13% of programs reported purely in-person didactics and 26% converted to all virtual didactics. The majority (53%-74%) of chief residents perceived virtual learning (in read-out, case conference, and didactic formats) to be less effective than in-person learning. One third of chief residents reported decreased procedural exposure during the pandemic, and 7%-9% of chief residents felt uncomfortable with basic procedures (basic fluoroscopy examinations, basic aspiration/drainage procedures, and superficial biopsy procedures). The number of programs with 24/7 attending coverage increased from 35% in 2019 to 49% in 2022. Body, neuroradiology, and interventional radiology were the most popular advanced training options among graduating radiology residents.

CONCLUSION

The COVID-19 pandemic had a profound impact on radiology training, particularly in terms of virtual learning. These survey results suggest that although digital learning offers increased flexibility, most residents still prefer in-person readout and didactics. Despite this, virtual learning will likely remain a viable option as programs continue to evolve following the pandemic.

Evidence for an adverse impact of remote readouts on radiology resident productivity: Implications for training and clinical practice

After their rapid adoption at the onset of the coronavirus pandemic, remote case reviews (remote readouts) between diagnostic radiology residents and their attendings have persisted in an increasingly remote workforce, despite relaxing social distancing guidelines. Our objective was to evaluate the impact of the transition to remote readouts on resident case volumes after the recovery of institutional volumes. We tabulated radiology reports co-authored by first-to-third-year radiology residents (R1-R3) between July 1 and December 31 of the first pandemic year, 2020, and compared to the prior two pre-pandemic years. Half-years were analyzed because institutional volumes recovered by July 2020. Resident volumes were normalized to rotations, which were in divisions categorized by the location of the supervising faculty during the pandemic period; in 'remote' divisions, all faculty worked off-site, whereas 'hybrid' divisions had a mix of attendings working on-site and remotely. All residents worked on-site. Data analysis was performed with Student's t test and multivariate linear regression. The largest drops in total case volume occurred in the two remote divisions (38% [6,086 to 3,788], and 26% [11,046 to 8,149]). None of the hybrid divisions with both in-person and remote supervision decreased by more than 5%. With multivariate regression, a resident assigned to a standardized remote rotation in 2020 would complete 32% (253 to 172) fewer studies than in identical pre-pandemic rotations (coefficent of -81.6, p = .005) but would be similar for hybrid rotations. R1 residents would be expected to interpret 40% fewer (180 to 108) cases on remote rotations during the pandemic (coefficient of -72.3, p = .007). No significant effect was seen for R2 or R3 residents (p = .099 and p = .29, respectively). Radiology residents interpreted fewer studies during remote rotations than on hybrid rotations that included in-person readouts. As resident case volume is correlated with clinical performance and board pass rate, monitoring the readout model for downstream educational effects is essential. Until evidence shows that educational outcomes remain unchanged, radiology residencies may wish to preserve in-person resident readouts, particularly for junior residents.

A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations

The Coronavirus Disease 2019 (COVID-19) pandemic ushered in rapid changes in healthcare, including radiology, globally. This review discusses the impact of the pandemic on various radiology departments globally. We analyze the implications of the COVID-19 pandemic on the imaging volumes, finances, and clinical operations of radiology departments in 2020. Studies from health systems and outpatient imaging centers were analyzed, and the activity throughout 2020 was compared to the pre-pandemic activity, including activity during similar timeframes in 2019. Imaging volumes across modalities, including MRI and CT scans, were compared, as were the Relative Value Units (RVUs) for imaging finances. Furthermore, we compared clinical operations, including staffing and sanitation procedures. We found that imaging volumes in private practices and academic centers decreased globally. The decreases in volume could be attributed to delayed patient screenings, as well as the implementation of protocols, such as the deep cleaning of equipment between patients. Revenues from imaging also decreased globally, with many institutions noting a substantial decline in RVUs and revenue compared with pre-COVID-19 levels. Our analysis thus found significant changes in the volumes, finances, and operations of radiology departments due to the COVID-19 pandemic.

Current Status of Burnout in Canadian Radiology

Burnout is a healthcare concern affecting physicians around the world. Physicians experiencing burnout tend to display signs of emotional exhaustion, depersonalization, and low personal accomplishment. Ongoing burnout trends have posed numerous challenges to Canadian physicians, notwithstanding the added complexity of the COVID-19 pandemic's impact in recent years. In particular, Canadian radiologists frequently reported experiencing high rates of burnout. This review aims to examine prominent factors affecting burnout in Canadian radiologists and summarize the impact of recent trends. In doing so, the overall wellbeing of Canadian radiologists can be assessed, and strategies for improvement can be discussed as the Canadian healthcare system prepares for new challenges of increasing demand and pressures.

Radiology Training Program Lessons Learned During the COVID-19 Pandemic

The COVID-19 pandemic had major effects on radiology training programs throughout the country. Many of the challenges were shared, with some variation depending on the size and geographic location of each program. While some initial modifications, such as platoon-type scheduling and redeployment, have been abandoned, other changes such as home workstations and the option of remote conferences have become more permanently incorporated. Remote learning tools and virtual teaching are much more frequently used, although there is emphasis by many programs on preserving in-person training. Programs stressed the importance of communication and adaptability, and getting resident and faculty input is key in optimizing the educational experience.

Work From Home in Academic Radiology Departments: Advantages, Disadvantages and Strategies for the Future

To achieve necessary social distancing during the Covid-19 pandemic, working from home was introduced at most if not all academic radiology departments. Although initially thought to be a temporary adaptation, the popularity of working from home among faculty has made it likely that it will remain a component of radiology departments for the long term. This paper will review the potential advantages and disadvantages of working from home for an academic radiology department and suggest strategies to try to preserve the advantages and minimize the disadvantages.

In-person radiologist to review the trauma panscan: a high-fidelity simulation training program for radiology trainees at an academic level 1 trauma center

BACKGROUND

Radiology trainees were uncomfortable going to the CT scanner to review trauma panscans and interacting with trauma surgeons.

OBJECTIVE

This study aims to determine if radiology residents can be trained to accurately identify injuries requiring immediate surgical attention at the CT scanner.

METHODS

A high-fidelity simulation model was created to provide an immersive training experience. Between February 2015 and April 2017, 62 class 1 trauma panscans were read at the CT scanner by 11 PGY-3 radiology residents. Findings made at the scanner were compared to resident preliminary and attending radiology reports and correlated with clinical outcomes. Timestamps were recorded and analyzed. Surveys were administered to assess the impact of training on radiology residents' self-confidence and to assess trauma surgeons' preference for radiology at the scanner. Significance level was set at p < 0.05.

RESULTS

The mean time to provide results at the CT scanner was 11.1 min. Mean time for the preliminary report for CT head and cervical spine was 24.4 ± 9.8 min, and for the CT chest, abdomen, and pelvis was 16.3 ± 6.9 min. 53 traumatic findings on 62 panscans were identified at the scanner and confirmed at preliminary and final reports, for a concordance rate of 85%, compared to 72% for the control group. Radiology residents agreed or strongly agreed the training prepared them for trauma panscan reporting. Trauma surgeons shifted in favor of radiology presence at the scanner.

CONCLUSION

Radiology residents can be trained to accurately and rapidly identify injuries requiring immediate surgical attention at the CT scanner.

CLINICAL IMPACT

These findings support the value-added of an in-person radiologist at the CT scanner for whole-body trauma panscans to facilitate timely detection of life-threatening injuries and improve professional relations between radiologists and trauma surgeons.

The use of technology in postgraduate medical education within radiology: a scoping review

Postgraduate radiology training has traditionally followed didactic approaches; however, complex reasoning skills and critical thinking are essential in the field of radiology. Therefore, the shortages of radiologists in Africa have necessitated the need to review the use of technology in postgraduate education to improve efficient training and service. This scoping review was conducted to map the evidence on the role of technology in postgraduate radiology education and practice. A systematic scoping review search strategy was undertaken to review material published between January 2005 and August 2020 on the use of technology in radiology education. Data from the included studies were extracted and analyzed for emerging themes and presented in response to the research question. Seven articles described studies from the African continent. The most popular technological intervention was telemedicine, and several niche areas of technology implementation were identified (blended learning, flipped learning, digital teaching files). Furthermore, the most challenging aspects relating to technology use remain fiscal and credentialing constraints. Technology plays a role in postgraduate radiology education through networks, synchronous and asynchronous applications. It has the potential to increase support to doctoral students in the African context and alleviate some stressors associated with traditional, face-to-face didactic programs.

Radiology trainee and attending satisfaction with virtual readouts during the COVID-19 pandemic

RATIONALE AND OBJECTIVES

In response to COVID-19, our institution implemented three virtual readout systems: a commercial HIPAA compliant web-based video conferencing platform used for screen-sharing (Starleaf), an interactive control sharing system integrated into PACS allowing simultaneous multi-user mouse control over images (Collaborate), and the telephone. Our aim was to assess overall satisfaction with and perceived effectiveness of these virtual readout methods to optimize best practices for the future.

MATERIALS AND METHODS

An IRB-exempt survey was electronically distributed to 64 trainees and 76 attendings at one tertiary-care institution via Survey Monkey. Questions focused on overall satisfaction, perceived effectiveness, technical difficulties, and continued future use of the three virtual readout strategies. Answers were collected with Likert scales, tick boxes, and open-ended questions.

RESULTS

32/64 trainees (50%) and 32/76 attendings (42%) completed the survey. Trainees and attendings were more satisfied with screen sharing (Starleaf) and perceived it more effective than control sharing (Collaborate) or the telephone (p < 0.0001). Respondents experienced more technical difficulties with control sharing versus screen sharing (p = 0.0004) with a negative correlation between level of technical difficulties and satisfaction with screen sharing (r = -0.50, p < 0.0001) and control sharing (r = -0.38, p = 0.0006). Trainees and faculty supported a combination of in-person and virtual readouts in the future (p < 0.0001).

CONCLUSION

Platforms mirroring in-person readouts, such as Starleaf, are preferred by both trainees and attendings over non-screen sharing platforms such as the telephone. However, technical stability determines satisfaction between similar platforms. Both trainees and attendings support incorporation of virtual readout methods in combination with traditional in-person readouts in the post-COVID-19 era.

Learning From Experience- Confronting Challenges and Adapting to Change in a Large Academic Abdominal Radiology Practice: Insights From a Faculty Retreat

RATIONALE

Substantial organizational changes, increasing clinical volumes, and the COVID-19 pandemic presented compound stressors to faculty radiologists in our large academic abdominal radiology division and necessitated multiple changes in our practice.

METHODS

To address the challenges and establish group consensus, we conducted a virtual divisional faculty retreat centered on themes of team building, clinical work, trainee education, and faculty mentorship. A pre-retreat survey evaluated satisfaction with aspects of professional life and clinical work practices and invited personal reflections. Survey data were presented in the retreat segments focused on each theme, and subsequent discussion was facilitated in small group breakouts.

RESULTS

Responses to the team-building survey revealed common values and sources of gratitude, including health, family and meaningful work and relationships. Faculty reported a strong sense of personal accomplishment, but with varied emotional exhaustion scores. Faculty were satisfied with remote work assignments but identified opportunities to improve the clinical work schedule including reversion of some remote assignments to in-person and increased interventional radiology shift staggering. Compared to pre-COVID practice, faculty respondents perceived giving lower quality and less frequent feedback to trainees; evolving educational resource needs were identified. A more formal approach to faculty mentoring was sought. A post-retreat survey revealed high participant satisfaction.

OUTCOMES

In the future, we plan to continue divisional retreat activities to respond to evolving challenges and further improve team building, clinical workflow, trainee education, and faculty mentorship.

Adapting to the Era of Virtual Recruitment: Radiology Departmental Website Response to COVID-19 and Portrayal of the Resident Experience

Rationale and Objectives

The COVID-19 pandemic has transformed radiology recruitment into a virtual affair and placed an even stronger emphasis on the importance of departmental websites. In this study, we evaluate residency websites in detailing the response to COVID-19 as well as initiatives which help describe the resident experience.

Materials and Methods

Program websites for diagnostic radiology residencies listed in the 2022 Electronic Residency Application Service (ERAS) program list were evaluated for 31 criteria related to departmental response to COVID-19, online outreach, and resident wellness.

Results

Of 184 programs, 182 had functioning websites for review. One program was excluded from analysis as the website was almost entirely video-based. In response to COVID-19, ≤1% described resident redeployment, vaccination information, departmental response to ABR Core Exam changes, or regular administration updates. Six (3.3%) described revised read-out protocols, four (2.2%) mentioned supplementary non-clinical education, and 14 (7.7%) indicated changes to educational conferences. The majority of websites (122, 67.4%) offered an informational or tour video, while 44 (24.3%) described expectations for virtual interviewing, and 20 (11.0%) had virtual “open-houses.” Departmental social media, primarily Twitter, was linked for 60 (33.1%) programs. A total of 134 (74.0%) websites described community highlights.

More than a quarter mentioned meal stipends (72, 39.8%), paid sick time (54, 29.8%) and healthcare resources (57, 31.5%). Although social activities were described by 44 (24.3%) programs, some specifically indicating changes to COVID-19, formal resident mentoring (25, 13.8%) and wellness committees (28, 15.5%) were less common. These criteria were found more commonly at the largest third of residency programs (chi square, p < 0.00625).

Conclusion

Programs rarely described work flow changes to COVID-19, and websites could improve in virtual outreach. Compared with prior literature, departmental websites have improved in describing wellness initiatives and related measures.

The Impact of the COVID-19 Pandemic on Radiology Resident Education: Where Do We Go From Here?

The Coronavirus Disease of 2019 (COVID-19) pandemic caused a dramatic shift in radiology resident education. Primarily, physical distancing prompted a general transition to virtual learning. Common changes made by radiology residency programs included virtual rounds and readouts, the use of simulation technology, and case-based learning which utilized pedagogical approaches such as the flipped classroom for teaching residents. Virtual learning appears to be a suitable alternative to traditional, in-person learning, and may have a place post-pandemic as part of a blended curriculum with in-person and virtual components. The extent of disruption to radiology resident education varied based on the local impact of COVID-19 and the prevalence of redeployment, as did residents’ mental health and wellbeing. Accessibility of mental health resources for residents was highlighted as an issue that programs need to address during these difficult times. Moreover, the pandemic resulted in unavoidable reductions in procedural exposure which programs mitigated through the use of simulation technologies and virtual learning resources. Professional development activities such as mentorship and career planning were also dramatically impacted by the pandemic and remains a challenge that programs need to consider moving forward post-pandemic. The purpose of this review is to outline the changes made to radiology resident education as a result of the COVID-19 pandemic and suggest what changes may be worthwhile to continue.

TeleResidents: Exploring the use of Resident Home Workstations During the COVID Pandemic

RATIONALE AND OBJECTIVES

Since the beginning of the COVID-19 pandemic, numerous strategies have been proposed to allow for continued resident education while following social distancing guidelines. Diagnostic radiology is largely electronic work, allowing for relatively easy transition to telehealth. Our institution deployed home workstations to interested upper level radiology residents and fellows in order to maintain high volume workload and education, while complying with CDC social distancing and quarantine guidelines.

MATERIALS AND METHODS

We deployed 28 home workstations with integrated PACS, electronic health record, and reporting system, supporting workflow that matched our on-site processes and allowing residents to work from home while on diagnostic rotations. Two months into the pilot, surveys were sent to trainees and faculty to assess satisfaction related to education, productivity, and wellness. A retrospective study count was performed for a sample of residents in order to assess productivity.

RESULTS

Residents perceived their remote productivity as unchanged or better than at the hospital, while faculty were more likely to perceive it as decreased, however, objective results showed no difference. Education was largely considered worse or unchanged with very few regarding it as improved. Those utilizing shared-screen signout platforms rated education better than those utilizing voice/telephone communications only. Trainees expressed improvement in wellness and quality of life.

CONCLUSION

Home workstations for trainees represent a feasible solution for implementing social distancing or even quarantine while maintaining operational productivity. There is the added benefit of scheduling flexibility, option to overcome space constraints, and improved quality of life.

Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70

BACKGROUND

The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations/innovation were implemented (description), their impact (justification), and 'how' and 'why' these were selected (explanation and rationale).

METHODS

The authors systematically searched four online databases up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.

RESULTS

Fifty-five articles were included. Most were from North America (n = 40), and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources, and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content.

CONCLUSIONS

This review highlights the response of medical educators in deploying adaptations and innovations. Whilst few are new, the complexity, concomitant use of multiple methods and the specific pragmatic choices of educators offers useful insight to clinical teachers who wish to deploy such methods within their own practice. Future works that offer more specific details to allow replication and understanding of conceptual underpinnings are likely to justify an update to this review.

Performance of Pediatric Neuroradiologists Working from Home during a Pandemic at a Quaternary Pediatric Academic Hospital

BACKGROUND AND PURPOSE

As a result of the coronavirus disease 2019 (COVID-19) pandemic, many radiology departments shifted to working a portion of clinical assignments from home. To determine the effect of working from home on performance, productivity, quality, and safety, we evaluated turnaround time, volume of studies, and error rates on rotations worked from home compared with in the hospital.

MATERIALS AND METHODS

The number of studies interpreted per day for each neuroradiologist, turnaround times, and error rates reported to peer learning was identified from April 1, 2020, through September 30, 2020. For each neuroradiologist, mean turnaround times and volumes per day at home versus in the hospital were compared. Similar comparison was performed for STAT studies.

RESULTS

During the time period, 2597 CTs (1897 at home, 700 in the hospital) and 3685 MRIs (2601 at home, 1084 in the hospital) were read. By individual neuroradiologists, 57% (4/7) had shorter turnaround time at home and 57% (4/7) demonstrated an increase in the mean number of studies per day read at home. No statistically significant difference was noted in the neuroradiologists' performance while reading STAT studies. Reported error rates were not found to be higher at home, with statistically significantly lower rates when working at home (P = .018).

CONCLUSIONS

Variable productivity and performance of neuroradiologists when working from home versus in the hospital were found, being 57% faster and/or more productive while working at home without an increase in error rates. The decision to work at home versus in the hospital may best be based on local factors, balancing the variability among individual neuroradiologist's and the institution's needs, recognizing that working from home is not a one-size-fits-all phenomenon but requires adaptability for successful implementation.

A Comparison of WebRTC and Conventional Videoconferencing for Synchronized Remote Medical Image Presentation

DICOM viewers must fulfill roles beyond primary diagnostic interpretation, including serving as presentation tools in teaching and multidisciplinary conferences, thereby enabling multiple individuals to review images collaboratively in real time. When in-person gathering is not possible, a variety of solutions have been deployed to maintain the ability for spatially separated users to view medical images simultaneously. These approaches differ in their backend architectures, utilization of application-specific optimizations, and ultimately in their end user satisfaction. In this work, we systematically compare the performance of conventional screensharing using a videoconferencing application with that of a custom, synchronized DICOM viewer linked using Web Real Time Communications (WebRTC) technology. We find superior performance for the WebRTC method with regard to image quality and latency across a range of simulated adverse network conditions, and we show how increasing the number of conference participants differentially affects the bandwidth requirements of the two viewing solutions. In addition, we compare these two approaches in a real-world teaching scenario and gather the feedback of trainee and faculty radiologists, who we found to favor the WebRTC method for its decreased latency, improved image quality, ease of setup, and overall experience. Ultimately, our results demonstrate the value of application-specific solutions for the remote synchronized viewing of medical imaging, which, given the recent increase in reliance on remote collaboration, may constitute a significant consideration for future enterprise viewer procurement decisions.

Clinical Learning in Medical and Health Professions Education amid COVID-19 Pandemic: A Literature Review of Various Methods and Innovations

BACKGROUND: COVID-19 has caused disruption to medical education and health care systems around the world. The highly contagious nature of the virus makes it difficult for educational institutions to continue their studies as usual, thus affecting the medical and health professions education which is based on face-to-face lectures, practicum, skills laboratories, and clinical practice in health facilities. AIM: This paper discovers clinical learning initiatives across the globe and highlights the contribution toward educational processes. METHODOLOGY: This study utilized an integrated literature review method. A systematic search for articles published was performed in Springer, ScienceDirect, PubMed, and EBSCOHost. Primary search monetary terms were e-learning (all synonyms) and health sciences education (all synonyms), including COVID-19. Articles published within the period of COVID-19 pandemic included in this study. For the synthesis, the 20 included studies selected were coded. In this study, data were synthesized through narrative synthesis using thematic analysis (TA). To identify the recurrent themes author followed six steps when synthesizing data using TA, for example, familiarizing with the data, developing initial (sub) codes, searching for (sub) themes, reviewing (sub) themes, compiling ideas or issues, and producing final data in line with the study aims and objectives. RESULTS: Out of records identified, a total of citations was screened, of which 20 were found to be of relevance to this study most were quantitative (14.70%) in design. Studies were published in 2020 since the beginning of COVID-19 pandemic. The geographical range of papers covered mostly the moderate-income regions. On conducting TA of the included studies, it was possible to obtain two broad descriptive themes/categories: enablers or drivers of, and barriers or challenges to, under which important themes have emerged. CONCLUSION: Study suggests that developing e-learning in effective clinical learning is needed, not only limited to moving the learning process but also needing to follow the instructional design, so that learning outcomes can be achieved by students. In addition, a learning process that promotes self-directed-learning is needed so that students have flexibility, use relevant learning styles and are able to integrate knowledge, skills and attitudes as a meaningful learning process.

Trainee and Faculty Perceptions of Remote PACS Workstations and Next Steps in a Large US Academic Medical Institution

Objective

Remote workstations were rapidly deployed in our academic radiology practice in late March 2020 in response to the COVID-19 pandemic. Although well-received by faculty, there were concerns for the impact on resident education.

Materials and Methods

Surveys of the radiology trainees and faculty were conducted online seven- and thirteen-months following workstation deployment as a part of a quality improvement project to assess the impact on radiology education and faculty wellness, as well as assess the desired trajectory of remote work in an academic setting.

Results

The majority of trainees (52%) reported the implementation had negatively impacted resident education, greatest among lower level residents (p < .001). This perception did not change despite interventions and perceived improvement in teleconferencing.

Greater than 75% of radiologists with remote workstations reported improved wellness and lower stress levels compared to the onsite radiologists. The majority of all respondents voted to continue or expand remote work following the COVID-19 pandemic in both surveys.

Conclusions

Onsite teaching is important for the education of residents, particularly for lower-level residents. However, the adoption of a hybrid model in an academic setting may prove beneficial for faculty wellness and recruitment of the next generation.

The Radiology Landscape after COVID-19: Summary of the 2021 AUR Academic Radiology and Industry Leaders Roundtable

The fifth Association of University Radiologists (AUR) Academic Radiology and Leaders Roundtable took place the day after the conclusion of the AUR annual meeting in May 2021 and involved leaders in academic radiology departments across the United States, and industry from companies who provide quintessential services to radiology departments. The open-ended discussion identified the key challenges facing the practice and business of radiology as we jointly move forward after the COVID-19 pandemic. Particular attention was paid to the identification of viable solutions that radiology departments should embrace to sustain clinical productivity, innovation, and well-being, and the ways that industry could contribute significantly to that endeavor.

COVID-19 pandemic revisited: lessons the radiology community has learned a year later

For more than 1 year, COVID-19 pandemic has impacted every aspect of our lives. This paper reviews the major challenges that the radiology community faced over the past year and the impact the pandemic had on the radiology practice, radiologist-in-training education, and radiology research. The lessons learned from COVID-19 pandemic can help the radiology community to be prepared for future outbreaks and new pandemics, preserve good habits, enhance cancer screening programs, and adapt to the changes in radiology education and scientific meetings.

Resident Experiences With Virtual Radiology Learning During the COVID-19 Pandemic

RATIONALE AND OBJECTIVES

COVID-19 has disrupted radiology education and forced a transition from traditional in-person learning to a virtual platform. As a result of hospital and state mandates, our radiology residency program quickly transitioned to a virtual learning platform to continue dissemination of knowledge, maintain resident engagement, and ensure professional development. The goal of this study is to assess the strengths and weaknesses of the virtual learning platform at our institution using resident ratings.

MATERIALS AND METHODS

This institutional IRB-exempt study involved a survey of 17 questions which was electronically distributed to 45 radiology residents using SurveyMonkey. Questions encompassed resident satisfaction with teaching and professional development, scheduling changes, and engagement with the virtual platform. Answers to most questions were submitted on a Likert scale.

RESULTS

A total of 31 of 45 respondents completed the survey (response rate = 69%). Most residents were satisfied with the virtual platform with teaching activities identified as a strength and the incorporation of professional development as a weakness. The most frequent barriers to attending the virtual curriculum were technical difficulties (43%) and childcare (36%). Residents who reported experiencing barriers were less likely to adhere to the virtual curriculum (p = 0.004). Most respondents (81%) reported a desire to maintain elements of the virtual learning practice postpandemic.

CONCLUSION

The majority of residents reported high satisfaction with virtual learning during the COVID-19 pandemic. Teaching activities are a curricular strength. Weaknesses identified include the incorporation of professional development and extrinsic barriers, such as technical difficulties and family obligations, which require further support for trainees.

Impact of COVID-19 on radiology training: Royal College of Radiologists Junior Radiologists Forum national survey

AIM

To obtain a national snapshot of radiology trainees' experience during the first wave of the pandemic.

MATERIALS AND METHODS

A 25-item questionnaire was disseminated to representatives from all training regions across the UK in July 2020. Each representative collated the collective experiences of trainees in their training programme in key domains, including redeployment, shielding, training, and teaching.

RESULTS

Ninety-five percent (38 of 40) of representatives completed the questionnaire. Trainees in up to 76% of training programmes were redeployed to wards and some trainees were shielding in 81% of programmes. Only 27% of programmes enabled remote reporting for isolating or shielding trainees. Sixty-two percent of respondents felt their well-being needs were supported. There was an overall increase in the attendance, volume, and quality of teaching and training nationally due to improved accessibility via remote-learning methods. Significant challenges were described with reporting, interventional procedures, and multidisciplinary team meeting attendance, although 62% of programmes noted an increase in service provision. Less in-person feedback was reported with in-person training still deemed necessary for practical skills. The Royal College of Radiologists Junior Radiologists Forum webinars were well received by all trainees with continuation of the series recommended.

CONCLUSION

The COVID-19 pandemic has had a clear impact on many areas of radiology training in the UK. Early strategies have been adopted to mitigate the challenges faced by trainees and opportunities for future improvement are highlighted.

Impact of the COVID-19 Pandemic on Breast Imaging Education

Objective

To determine the impact of the COVID-19 pandemic on breast imaging education.

Methods

A 22-item survey addressing four themes during the early pandemic (time on service, structured education, clinical training, future plans) was emailed to Society of Breast Imaging members and members-in-training in July 2020. Responses were compared using McNemar's and Mann-Whitney U tests; a general linear model was used for multivariate analysis.

Results

Of 136 responses (136/2824, 4.8%), 96 U.S. responses from radiologists with trainees, residents, and fellows were included. Clinical exposure declined during the early pandemic, with almost no medical students on service (66/67, 99%) and fewer clinical days for residents (78/89, 88%) and fellows (48/68, 71%). Conferences shifted to remote live format (57/78, 73%), with some canceled (15/78, 19%). Compared to pre-pandemic, resident diagnostic (75/78, 96% vs 26/78, 33%) (P < 0.001) and procedural (73/78, 94% vs 21/78, 27%) (P < 0.001) participation fell, as did fellow diagnostic (60/61, 98% vs 47/61, 77%) (P = 0.001) and procedural (60/61, 98% vs 43/61, 70%) (P < 0.001) participation. Most thought that the pandemic negatively influenced resident and fellow screening (64/77, 83% and 43/60, 72%, respectively), diagnostic (66/77, 86% and 37/60, 62%), and procedural (71/77, 92% and 37/61, 61%) education. However, a majority thought that decreased time on service (36/67, 54%) and patient contact (46/79, 58%) would not change residents' pursuit of a breast imaging fellowship.

Conclusion

The pandemic has had a largely negative impact on breast imaging education, with reduction in exposure to all aspects of breast imaging. However, this may not affect career decisions.

An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64

BACKGROUND

COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research.

METHODS

The authors followed the five stages of a scoping review outlined by Arskey and O'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts.

RESULTS

One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement).

CONCLUSIONS

This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.

Enabling Your Radiology Business to Thrive Strategic Lessons Learned During the Initial and Subsequent Surges of the Covid-19 Pandemic

The Covid-19 pandemic surges of 2020 resulted in major operational, personal, and financial impacts on US radiology practices. In response, a series of strategic and intentional operational changes were implemented, varying by practice size, structure and model. In reviewing the many business lessons that we learned during the pandemic, it became clear that for a business to be successful, a host of additional supportive factors are necessary. In addition to timely expense reductions, optimizing revenue capture and close monitoring and management of cash and reserves available for use, we also consider effective leadership and communication strategies, maintenance of a healthy and adequately staffed team, support for a remote work environment and flexible staffing models. Other ingredients include effectively embracing digital media for communications, careful attention to current and new stakeholders and the service delivered to them, understanding federal and state regulatory changes issued in response to the pandemic, close collaboration with the Human Resources office, and an early focus on redesigning your future practice structure and function, including disaster and downtime planning. This review aims to share lessons to enable leaders of an imaging enterprise to be better prepared for similar and future surges.

Virtual Radiology Readouts After the Coronavirus Disease (COVID-19) Pandemic

Social distancing concerns arising from the coronavirus disease (COVID-19) pandemic have led to the emergence of virtual readouts in radiology training programs. Given the myriad benefits of virtual readouts, radiology departments should continue using virtual readouts in at least a hybrid format, even after social distancing restrictions become relaxed. This article highlights the challenges and opportunities associated with virtual readouts and provides guidance and strategies for their long-term implementation by training programs.

Impact of the COVID-19 outbreak on the profession and psychological wellbeing of radiologists: a nationwide online survey

Background

The COVID-19 outbreak has played havoc within healthcare systems, with radiology sharing a substantial burden. Our purpose is to report findings from a survey on the crisis impact among members of the Italian Society of Medical and Interventional Radiology (SIRM).

Methods

All members were invited to a 42-question online survey about the impact of the COVID-19 outbreak on personal and family life, professional activity, socioeconomic and psychological condition. Participants were classified based on working in the most severely affected Italian regions (“hot regions”) or elsewhere.

Results

A total of 2150 radiologists joined the survey. More than 60% of respondents estimated a workload reduction greater than 50%, with a higher prevalence among private workers in hot regions (72.7% vs 66.5% elsewhere, p = 0.1010). Most respondents were concerned that the COVID-19 outbreak could impact the management of non-COVID-19 patients and expected a work overload after the crisis. More than 40% were moderately or severely worried that their professional activity could be damaged, and most residents believed that their training had been affected. More than 50% of respondents had increased emotional stress at work, including moderate or severe symptoms due to sleep disturbances, feeling like living in slow motion and having negative thoughts, those latter being more likely in single-living respondents from hot regions [log OR 0.7108 (CI95% 0.3445 ÷ 1.0770), p = 0.0001].

Conclusions

The COVID-19 outbreak has had a sensible impact on the working and personal life of SIRM members, with more specific criticalities in hot regions. Our findings could aid preserving the radiologists’ wellbeing after the crisis.

Medical Student Engagement and Educational Value of a Remote Clinical Radiology Learning Environment: Creation of Virtual Read-Out Sessions in Response to the COVID-19 Pandemic

RATIONALE AND OBJECTIVES

The need for social distancing has resulted in rapid restructuring of medical student education in radiology. While students traditionally spend time learning in the reading room, remote clinical learning requires material shared without direct teaching at the radiology workstation. Can remote clinical learning meet or exceed the educational value of the traditional in-person learning experience? Can student engagement be matched or exceeded in a remote learning environment?

MATERIALS AND METHODS

To replace the in-person reading room experience, a small-group learning session for medical students named Virtual Read-Out (VRO) was developed using teleconferencing software. After Institutional Review Board approval, two student groups were anonymously surveyed to assess differences in student engagement and perceived value between learning environments: "Conventional" students participating in the reading room (before the pandemic) and "Remote" students participating in VRO sessions. Students reported perceived frequency of a series of five-point Likert statements. Based on number of respondents, an independent t-test was performed to determine the significance of results between two groups.

RESULTS

Twenty-seven conventional and 41 remote students responded. Remote students reported modest but significantly higher frequency of active participation in reviewing radiology exams (p < 0.05). There was significantly lower frequency of reported boredom among Remote students (p < 0.05). There was no significant difference in perceived educational value between the two groups.

CONCLUSION

Students report a high degree of teaching quality, clinical relevance, and educational value regardless of remote or in-person learning format. Remote clinical radiology education can be achieved with equal or greater student interaction and perceived value in fewer contact hours than conventional learning in the reading room.

Lessons Learned From the Effects of COVID-19 on the Training and Education Workflow of Radiology Residents-A Time for Reflection: Perspectives of Residency Program Directors and Residents in Canada

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has led to widespread changes in all health care settings including academic radiology departments. The purpose of this survey-based study was to investigate the impact of COVID-19 on radiology resident training and education workflow in Canada in terms of the nature, scale, and heterogeneity of the changes, preparedness and adaptation, and perceptions of the present and future of radiology training.

METHODS

A 30-question web-based survey was sent to 17 radiology residency program directors across Canada. A separate 32-question survey was sent to 460 residents currently enrolled in a radiology residency in Canada. These surveys were open for 3 weeks.

RESULTS

We received responses from 16 program directors and 80 residents (response rates 94.1% and 17.4%, respectively). Most respondents agreed that objectives were being met for knowledge and interpretation but less so for case volumes and technical skills. Less time was allotted for on-site activities (eg, readouts) with more time for off-site activities (eg, videoconferencing). Daytime rotations were at least partly cancelled. Most respondents felt these changes were met with enthusiasm by both faculty and residents. However, there were perceived challenges including lack of training on virtual platforms for delivery of teaching and decreased staff-resident interaction, with short- and long-term anxiety reported.

CONCLUSIONS

The coronavirus disease 2019 has dramatically changed radiology resident training in Canada, with increased virtual learning at the expense of cancelled rotations and the resultant reduction in case volumes and staff-resident interaction. Although adopted with enthusiasm, these changes present substantial challenges and anxiety regarding the future of radiology resident education.

Beyond business as usual: Radiology residency educational response to the COVID-2019 pandemic

The COVID-19 pandemic has disrupted standard hospital operations and diagnostic radiology resident education at academic medical centers across the country. Deferment of elective surgeries and procedures coupled with a shift of resources toward increased inpatient clinical needs for the care of COVID-19 patients has resulted in substantially decreased imaging examinations at many institutions. Additionally, both infection control and risk mitigation measures have resulted in minimal on-site staffing of both trainees and staff radiologists at many institutions. As a result, residents have been placed in nonstandard learning environments, including working from home, engaging in a virtual curriculum, and participating in training sessions in preparation for potential reassignment to other patient care settings. Typically, for residents to gain the necessary knowledge, skills, and experience to practice independently upon graduation, radiology training programs must provide an optimal balance between resident education and clinical obligations. We describe our experience adapting to the challenges in educational interruptions and clinical work reassignments of 41 interventional and diagnostic radiology residents at a large academic center. We highlight opportunities for collaboration and teamwork in creatively adjusting and planning for the short and long-term impact of the pandemic on resident education. This experience shows how the residency educational paradigm was shifted during a pandemic and can serve as a template to address future disruptions.

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The COVID-19 pandemic disrupted normal operations and trainee education in our large academic medical center.

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Multitiered crisis staffing model and weekly schedule created to accommodate clinical demands and public health needs.

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Robust virtual curriculum included synchronous and asynchronous sessions for subspecialty-specific clinical education.

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Prepared for resident reassignment to other patient care settings such as medicine inpatient units.

Challenges faced by women in radiology during the pandemic - A summary of the AAWR Women's Caucus at the ACR 2020 annual meeting

The COVID-19 pandemic has dramatically altered the professional and personal lives of radiologists and radiation oncologists. This article summarizes the 2020 American Association for Women in Radiology (AAWR) Women's Caucus at the American College of Radiology (ACR) Annual Meeting. The caucus focused on the major challenges that women in radiology have faced during the pandemic.