The Clinician-Educator Pathway in Radiology: An Analysis of Institutional Promotion Criteria

Virtual Visiting Professorship Program as an Opportunity for Academic and Clinical Advancement Beyond the COVID-19 Pandemic: A Survey of Participants

OBJECTIVE

To identify structure, benefits, and shortcomings of a multi-institutional virtual visiting professorship (VVP) program from 2020 to 2022, 2 years after inception and after gradual resumption of an in-person, prepandemic academic environment.

METHODS

An IRB-exempt, 70-question survey about structure, benefits, and shortcomings of the VVP program was distributed to its participants (14 breast imaging departments across the U.S.), using the snowball sampling technique.

RESULTS

A total of 72 responses were received; 54.2% (32/59) radiologists >5 years of experience, 18.6% (11/59) radiologists <5 years of experience, 15.3% (9/59) residents, and 8.5% (5/59) fellows. Radiologists' attendance increased from 8% (5/59) to 53% (31/59) over 2 years, with 69% (41/59) of respondents supporting continued participation. The most important factors for attendance were expanding breast imaging knowledge (86.4% [51/59]) and the virtual format (76.2% [45/59]). The number of presented lectures increased from 1 to 3 lectures in 43.7% (7/16) of programs in year 1 and from 4 to 9 lectures in 50% (8/16) of programs in year 2. The greatest professional benefits were collaborations on publications for organizers (56.3% [9/16]) and building academic portfolios for presenters (50% [7/14]). For trainees, attending the program increased their knowledge (64.3% [9/14]) and enthusiasm for breast imaging (50% [7/14]).

CONCLUSION

The VVP program facilitated scholarly collaboration among breast imaging radiologists, promoted academic portfolios for junior faculty, and increased enthusiasm for breast imaging for trainees. These accomplishments extended beyond the COVID-19 pandemic, as evidenced by the growth of the program after resumption of an in-person academic environment. Future expansion to other programs would benefit more practicing radiologists.

The Second Mountain: Climbing the Challenges of Midcareer Radiology

A radiologist's career can be divided into the early, middle, and late phases. The midcareer phase is a particularly difficult period and has the highest rate of burnout among radiologists. Often throughout the early phase of a radiologist's career, during residency, fellowship, and while a junior faculty member, there is an abundance of support to help in personal and professional growth, but this support often wanes as radiologists gain seniority. Unfortunately, this often leaves midcareer radiologists feeling forgotten, or "invisible." This lack of support can lead to burnout, decreased job satisfaction, and premature departure from the workforce. The purpose of this review is to bring to light the challenges, such as higher rates of burnout and career stagnation, in addition to the lack of emphasis placed on midcareer mentorship, sponsorship, and career development programs, facing radiologists while climbing the "second mountain" of their career, as well as to provide potential individual and institutional interventions to combat these challenges. In addition, emphasis will be placed on the difficulties experienced by midcareer female radiologists, whose challenges are particularly problematic and to our knowledge have received little attention in the imaging literature to date.

Are Academic Emergency Radiologists Systematically Disadvantaged Compared With Diagnostic Radiology Subspecialty Counterparts When It Comes to Promotion?

PURPOSE

The aim of this study was to assess academic rank differences between academic emergency and other subspecialty diagnostic radiologists.

METHODS

Academic radiology departments likely containing emergency radiology divisions were identified by inclusively merging three lists: Doximity's top 20 radiology programs, the top 20 National Institutes of Health-ranked radiology departments, and all departments offering emergency radiology fellowships. Within departments, emergency radiologists (ERs) were identified via website review. Each was then matched on career length and gender to a same-institutional nonemergency diagnostic radiologist.

RESULTS

Eleven of 36 institutions had no ERs or insufficient information for analysis. Among 283 emergency radiology faculty members from 25 institutions, 112 career length- and gender-matched pairs were included. Average career length was 16 years, and 23% were women. The mean h indices for ERs and non-ERs were 3.96 ± 5.60 and 12.81 ± 13.55, respectively (P < .0001). Non-ERs were twice as likely as ERs (0.21 versus 0.1) to be associate professors at h index < 5. Men had nearly 3 times the odds of advanced rank compared with women (odds ratio, 2.91; 95% confidence interval, 1.02-8.26; P = .045). Radiologists with at least one additional degree had nearly 3 times the odds of advancing rank (odds ratio, 2.75; 95% confidence interval, 1.02-7.40; P = .045). Each additional year of practice increased the odds of advancing rank by 14% (odds ratio, 1.14; 95% confidence interval, 1.08-1.21; P < .001).

CONCLUSIONS

Academic ERs are less likely to achieve advanced rank compared with career length- and gender-matched non-ERs, and this persists even after adjusting for h index, suggesting that academic ERs are disadvantaged in current promotions systems. Longer term implications for staffing and pipeline development merit further attention as do parallels to other nonstandard subspecialties such as community radiology.

Analysis of Teaching-Related Criteria Within Promotion and Tenure Documents from US Pharmacy Schools

OBJECTIVE

To describe teaching-related criteria within promotion and tenure (PT) guidance documents from US-based colleges/schools of pharmacy.

METHODS

PT guidance documents were retrieved from college/school websites or via electronic mail. Institutional characteristics were compiled using available online data. Using qualitative content analysis, a systematic review of PT guidance documents was conducted to identify how teaching and teaching excellence were considered in decision of promotion and/or tenure at each institution.

RESULTS

PT guidance documents were analyzed from 121 (85%) colleges/schools of pharmacy. Of these, 40% included a requirement that faculty must achieve excellence in teaching for promotion and/or tenure, though excellence was infrequently defined (14% of colleges/schools). Criteria specific to didactic teaching were most frequently included (94% of institutions). Criteria specific to experiential (50%), graduate student (48%), postgraduate (41%), and interprofessional (13%) teaching were less frequently included. Institutions frequently required student (58%) and peer (50%) evaluations of teaching to be considered in PT decisions. Most institutions acknowledged many teaching accomplishments as examples indicating teaching success rather than strictly requiring specific criteria to be fulfilled.

CONCLUSION

Teaching-related criteria within PT criteria of colleges/schools of pharmacy often lack clear guidance regarding quantitative or qualitative requirements for advancement. This lack of clearly specified requirements may result in faculty members' inability to self-assess for readiness for promotion and inconsistent application of criteria in PT decisions by review committees and administrators.

Academic Radiology in the United States: Defining Gender Disparities in Faculty Leadership and Academic Rank

RATIONALE AND OBJECTIVES

Female physicians in academic medicine have faced barriers that potentially affect representation in different fields and delay promotion. Little is known about gender representation differences in United States academic radiology departments, particularly within the most pursued subspecialties.

PURPOSE

To determine whether gender differences exist in United States academic radiology departments across seven subspecialties with respect to academic ranks, departmental leadership positions, experience, and scholarly metrics.

MATERIALS AND METHODS

In this cross-sectional study from November 2018 to June 2020, a database of United States academic radiologists at 129 academic departments in seven subspecialties was created. Each radiologist's academic rank, departmental leadership position (executive-level - Chair, Director, Chief, and Department or Division Head vs vice-level - vice, assistant, or associate positions of executive level), self-identified gender, years in practice, and measures of scholarly productivity (number of publications, citations, and h-index) were compiled from institutional websites, Doximity, LinkedIn, Scopus, and official NPI profiles. The primary outcome, gender composition differences in these cohorts, was analyzed using Chi² while continuous data were analyzed using Kruskal-Wallis rank sum test. The adjusted gender difference for all factors was determined using a multivariate logistic regression model.

RESULTS

Overall, 5086 academic radiologists (34.7% women) with a median 14 years of practice (YOP) were identified and indexed. There were 919 full professors (26.1% women, p < 0.01) and 1055 executive-level leadership faculty (30.6% women, p < 0.01). Within all subspecialties except breast imaging, women were in the minority (35.4% abdominal, 79.1% breast, 12.1% interventional, 27.5% musculoskeletal, 22.8% neuroradiology, 45.1% pediatric, and 19.5% nuclear; p < 0.01). Relative to subspecialty gender composition, women full professors were underrepresented in abdominal, pediatric, and nuclear radiology (p < 0.05) and women in any executive-level leadership were underrepresented in abdominal and nuclear radiology (p < 0.05). However, after adjusting for h-index and YOP, gender did not influence rates of professorship or executive leadership. The strongest single predictors for professorship or executive leadership were h-index and YOP.

CONCLUSION

Women academic radiologists in the United States are underrepresented among senior faculty members despite having similar levels of experience as men. Gender disparities regarding the expected number of women senior faculty members relative to individual subspecialty gender composition were more pronounced in abdominal and nuclear radiology, and less pronounced in breast and neuroradiology. Overall, h-index and YOP were the strongest predictors for full-professorship and executive leadership among faculty.

KEY RESULTS

● Though women comprise 34.7% of all academic radiologists, women are underrepresented among senior faculty members (26.1% of full professors and 30.6% of executive leadership) ● Women in junior faculty positions had higher median years of practice than their male counterparts (10 vs 8 for assistant professors, 21 vs 13 for vice leadership) ● Years of practice and h-index were the strongest predictors for full professorship and executive leadership.

The ADVICER Template for Faculty Reviewer Letters for Promotion and Appointment

RATIONALE AND OBJECTIVES

Promotion is an important milestone in the career of academic radiologists. Appointments, Promotion and Tenure (APT) committees require multiple letters of support from both internal and external referees. Traditional narrative letters are highly subjective, have high inter-reader variability, are time-intensive, and vulnerable to gender and other biases. The Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER) recognized the need for a standardized template to assist academic faculty, letter writers, and APT committees.

MATERIALS AND METHODS

An ADVICER ad hoc committee of six educators with experience serving as external referees was convened to create a standardized template. Committee members performed a search of the relevant literature and internet sites, spoke with stakeholders such as APT chairs, and ultimately developed a template for faculty reviewer letters using the common clinician-educator pathway as a focal point.

RESULTS

An open source, modifiable, standardized, template was produced. The template has been made available to ADVICER members and is available on the Association of University Radiologists (AUR) website at: https://www.aur.org/resources/Template-for-Faculty-Reviewer-Letters-for-Promotion-and-Appointment CONCLUSION: This external referee template has the potential to reduce subjectivity, eliminate bias, and provide a flexible, modifiable, comprehensive faculty review letter template which will be useful for academic faculty, letter writers, and promotions committees.

Resident Clinician Educator Leadership Pathway Tracks in US Radiology Programs: An ADVICER 2021 Survey Study

RATIONALE AND OBJECTIVES

The purpose of this manuscript is to elucidate the prevalence, characteristics, outcomes, and perceptions of Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER) members on Clinician Educator Leadership Pathway (CELP) tracks in diagnostic and interventional radiology residency programs in the United States.

MATERIALS AND METHODS

IRB exemption was obtained for this study. A 17-question anonymous survey was administered to the ADVICER members, an Association of University Radiologists (AUR) affiliate group, via email once, and then as a reminder 14 days later. Statistical analysis occurred via built-in analytics of the survey vendor, SurveyMonkey.

RESULTS

Thirty five of 72 ADVICER members (48.6%) responded to the survey. 45.7% (16/35) respondents indicated the presence of leadership or specialty pathways in their respective residencies. 28.6% of respondents indicated a CELP (10/35) in their residency programs. 92.0% of respondents endorsed CELP as preparatory for an academic career, and 93.6% endorsed development of a national CELP curriculum.

CONCLUSION

The majority of radiology residency programs do not have a CELP in their training curriculum. ADVICER leaders overwhelmingly support CELP for professional development of the future educational leaders in radiology and endorse the creation of a national CELP curriculum.

Vice Chair for Education: Twelve Roles to Provide a Framework for Success

RATIONALE AND OBJECTIVES

An increase in the administrative work in our healthcare system has led to an increase in the number of administrative positions in radiology departments. Many of these are Vice Chair roles, including Vice Chair for Education (VCEd). The responsibility of this position has expanded, often far beyond the original definition. This article defines the role and expectations of the Vice Chair for Education and provides suggestions for success.

MATERIALS AND METHODS

This article will review 12 vital roles that a Vice Chair for Education must play to be an effective advocate for radiology education within a department.

RESULTS

Key attributes of an educational leader are delineated, divided into 12 areas or roles.

CONCLUSION

This article summarizes key leadership skills needed by Vice Chairs for Education in order for them to be effective in their role.

Mitigating delayed academic promotion of female radiologists due to the COVID pandemic

Achieving promotion in rank is considered an important measure of career success for academic radiologists. Multiple studies have shown prevailing gender inequities disadvantaging women in medicine. The recent global pandemic due to COVID-19 has affected all parts of society but has disproportionately impacted women and may delay academic promotion of female academic radiologists. We reviewed the evidence regarding the potential career impact of the COVID-19 pandemic on female radiologists. The pandemic has disproportionately increased women's domestic and childcare responsibilities and decreased female researchers' productivity which may delay academic promotion. Strategies to address the problem of delayed promotion of female radiologists include raising awareness, mentorship and sponsorship, operational flexibility, and support with domestic and childcare responsibilities.

Analysis of Research and Scholarship Criteria Within Promotion and Tenure Documents of US Pharmacy Schools

Objective. To describe criteria for evaluating faculty scholarship within the promotion and tenure guidance documents of US schools and colleges of pharmacy.Methods. Promotion and tenure documents were obtained from the websites of US pharmacy schools or requested via electronic mail, and institutional characteristics were collected from publicly available online data. A qualitative content analysis was conducted to systematically catalogue document characteristics and criteria for promotion and tenure.Results. Promotion and tenure guidance documents from 121 (85%) of 142 pharmacy schools were analyzed. Institutions were 55% public and equally distributed across Carnegie institutional classifications as well as geographic and extramural funding stratifications. Publications (94%) and grants and contracts (87%) were the most frequently included criteria for faculty advancement. More than 50% of schools recognized the criteria within promotion and tenure guidance documents but did not explicitly require faculty to achieve them before receiving promotion and/or tenure. For institutions that required publications for advancement, the most frequently required criterion was publication in peer-reviewed journals (47%). Few schools (22%) documented a specific number of required publications.Conclusion. This analysis provides a comprehensive review of scholarship criteria in academic pharmacy promotion and tenure guidance documents. There was wide variability among scholarship criteria, and documents often lacked specific language defining scholarship requirements. As a result, faculty may find the documents less helpful for self-assessment and preparation toward promotion and/or tenure. These benchmark data can assist pharmacy faculty and administrators in developing and revising promotion and tenure guidance documents to include clear criteria and better align with peer institutions.

Social Media and Radiology Education: Are We #Ready?

Social media has become integrated into the lives of millions of people, but it has only recently been explored as a potential teaching tool. There is a body of literature to suggest that today's learners desire use of these interactive platforms for learning and that they result in higher degrees of student satisfaction, although it is not yet clear that a greater degree of knowledge transfer or retention is achieved. There are barriers to implementation in a curriculum, but as we learn to overcome these barriers and find new and creative ways to leverage social media we as educators will meet our students needs in the era of "web 2.0" and the digital native generation.

Cultivating Future Radiology Educators: Development and Implementation of a Clinician-Educator Track for Residents

Effective and dedicated educators are critical to the preservation and advancement of the practice of radiology. The need for innovative and adaptable educators is increasingly being recognized, with several institutions granting academic promotions through clinician-educator tracks. The implementation of resident "clinician-educator tracks" or "teaching tracks" should better prepare residents aspiring to become academic radiologists focused on teaching. In this work, we describe our experience in the development and implementation of a clinician-educator track for diagnostic radiology residents at our institution.