Developing a Late-Career Roadmap to Continued Career Engagement

Professional development needs span the entirety of a radiologist's career. Great strides have been made in the creation of an infrastructure for early career development. Work is ongoing to develop such resources for mid-career radiologists, given the recent recognition of the needs of this group. Unfortunately, even less attention has been paid to late-career radiologist development needs as a bridge to retirement. As part of the Career Conversations series, this article will highlight the needs and currently available resources for this group.

APDR Healthcare Disparities Curriculum Pilot: Helping Trainees Meet More Than a Milestone

RATIONALE AND OBJECTIVES

In order to help program directors satisfy the Accreditation Council for Graduate Medical Education common program requirement for health care disparities (HCD) education, a comprehensive web-based curriculum on HCDs in Radiology was developed. The curriculum was designed to educate trainees about existing HCDs, stimulate discussion, and spur research about HCDs in radiology. The curriculum was piloted to assess its educational value and feasibility.

MATERIAL AND METHODS

A comprehensive curriculum comprised of four modules (1) Introduction to HCDs in Radiology, (2) Types of HCDs in Radiology, (3) Actions to Address HCDs in Radiology, and (4) Cultural Competency was created and housed on the Associate of Program Directors in Radiology website. Various educational media including recorded lectures or PowerPoint presentations, small group discussions, and journal clubs were employed. A pilot program was initiated to evaluate the benefits of this curriculum for resident education and consisted of a pre- and post-curriculum test for trainees, an experience survey for trainees, and a pre- and post-administration survey for facilitators.

RESULTS

Forty-seven radiology residency programs participated in the pilot of the HCD curriculum. Of those facilitating the curriculum, 83% indicated lack of standardized curriculum as a perceived barrier to implementing a HCD curriculum at their program on the pre-survey. Trainee knowledge scores increased from 65% (pre) to 67% (post) (p = 0.05). Following curriculum participation, residents indicated an increase in adequate understanding of HCDs in Radiology (81% post vs. 45% pre). Most program directors (75%) found the curriculum easy to implement.

CONCLUSION

This pilot study demonstrated that the APDR Health Care Disparities curriculum increased trainee awareness of HCDs. The curriculum also provided a forum for important discussions about HCDs.

ACGME Diagnostic Radiology Milestones 2.0: the Time is Now

The Accreditation Council for Graduate Medical Education oversees graduate medical education in the United States. Designed to provide broad based training in all aspects of imaging, the diagnostic radiology residency program must provide educational experiences that not only provide technical, professional, and patient centered training, but also meet accreditation standards. With the breadth of material to cover during training, carefully orchestrated educational experiences must be planned. This manuscript offers residency program leaders resources to meet the challenges of the new Accreditation Council for Graduate Medical Education Diagnostic Radiology Milestones 2.0 and highlights potential opportunities for future educational endeavors.

Strengthening the Clinical Learning Environment by Mandate-Implementing the ACGME Common Program Requirements

RATIONALE

Three years ago, the Accreditation Council for Graduate Medical Education (ACGME) introduced updated Common Program Requirements in recognition of the need to further promote resident and faculty member well-being and patient safety. The ACGME acknowledged residencies would need time to comply with new requirements. This grace period, however, concluded as of July 1, 2019, and programs now risk citations for failure to implement new requirements.

METHODS AND RESULTS

The authors, members of the Association of Program Directors in Radiology Common Program Requirements Ad Hoc committee, developed downloadable resources provided in the Appendix delineating the 2019 Common Program Requirements and offering sample resources as compliant solutions.

CONCLUSION

The resources offer a national standardized approach to educating trainees in these essential skills and should be especially helpful to programs with access to fewer resources. In addition to achieving compliance, incorporation of these resources into residency training will ensure the next generation of radiologists are equipped to add value while remaining physically and emotionally healthy.

Health Care Disparities in Radiology-A Review of the Current Literature

INTRODUCTION

Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology.

METHODS

We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. 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 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis.

DISCUSSION

We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.

Addressing the ACGME Mandate for Healthcare Disparities Education in Residency Programs: A Needs Assessment

PURPOSE

To assess current opinions and efforts from radiology residency program leadership regarding healthcare disparities (HCD) education for residents.

METHODS

Radiology residency program directors across the United States were sent a 10-item survey and asked a series of qualitative questions regarding their opinions about HCD and current methods of implementation into their residency curriculum, in addition to demographic information such as program location and setting.

RESULTS

73 out of 334 program directors responded. 49.3% were located in the Northeast, 16.4% in the Southeast, 16.4% in the Midwest, 12.3% in the Southwest, and 5.5% in the Pacific. Community programs made up 16.4% of respondents, while academic programs made up 76.7%. 6.8% identified as "other". 98.6% agreed with the provided definition of HCD. 83.6% agreed or strongly agreed that HCD present an obstacle to providing imaging care. 74.0% agreed or strongly agreed that HCD education is an essential component of residency training. However, 74.0% agreed or strongly agreed that HCD education is difficult to implement due to competing educational requirements. Only 16.4% agreed or strongly agreed that they had sufficient material on HCD to train residents.

CONCLUSION

Although many radiology residency programs agree that HCD education is essential in residency training, the majority feel that a curriculum is difficult to implement and that they lack sufficient resources. This study confirms the need to address this gap with a standardized curriculum which has been developed and is discussed.

Adding value to imaging services: a survey of patient and referring physician preferences for direct radiologic reporting of results

PURPOSE

To identify preferences of patients and referring physicians for direct patient communication and notification of radiologic study results.

METHODS

An anonymous survey was conducted of patients undergoing outpatient radiologic imaging studies and their referring physicians. The voluntary surveys elicited responses regarding preferences on a 5-point Likert scale (Strongly disagree, disagree, neutral, agree and strongly agree), as well as indicated by responding yes or no to specific questions.

RESULTS

368 patients completed the survey. 81.5% of patient responders preferred all results communicated from the radiologist within the same day. 65.9% of patients preferred same day results if normal vs 65.8% if abnormal. 34.5% preferred to wait and review normal results with the referring physician. 41.5% preferred to wait and review abnormal results with the referring physician. It was found that patients were more likely to strongly agree with waiting to review results with the referring physician if the results were abnormal, as opposed to normal (18.5% vs 11.9%, respectively; P < 0.014). 64% of physicians did not want results reviewed with their patients; 87.6% did not want a report sent to the patient by the radiologist, even after report was sent to their office. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety.

CONCLUSIONS

58-82% of patients preferred same day radiologist communication of their results while 55-87.6% of physicians did not prefer same day radiologist communication of results directly with their patients. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety.

Should Radiologists Comment on Incidental Findings of Vascular Calcifications Found on Abdominal/Pelvic CT in Patients Less Than 50 Years of Age?

RATIONALE AND OBJECTIVES

To evaluate if incidental abdominopelvic calcified atherosclerosis (ACA) in patients under 50 years of age correlates with cardiovascular disease (CVD) risk factors. Most studies evaluating calcific atherosclerosis and associated increased risk of CVD have concentrated on middle age and older populations.

MATERIALS AND METHODS

A retrospective review of 519 emergency department patients, aged 25-50 years, receiving computed tomography (CT) was performed and ACA correlated with lipid panels obtained via chart review. Those with calcified atherosclerosis were subdivided by vessel location and calcification burden (mild, moderate, or severe). Patients were followed for six years. Normality, Wilcoxon-Mann-Whitney, Kruskal-Wallis, and chi-square tests were performed.

RESULTS

Two hundred and sixty-nine patients with incidental ACA on CT and 250 without ACA were studied. Atherosclerotic calcifications had a statistically significant correlation with elevated triglyceride (128 mg/dL vs 105 mg/dL; p = 0.0003) and decreased high-density lipoprotein (38 mg/dL vs 41 mg/dL; p = 0.0032) as compared to the control. Patients with ACA were at higher risk of stroke, heart attack, and death (p < 0.0001) during a six-year follow-up period.

CONCLUSION

Incidental atherosclerotic calcification on abdominopelvic CT in patients under 50 years of age correlated with elevated triglycerides and decreased high-density lipoprotein as well as higher risk of cardiovascular events. Since radiologists may be the first to identify this finding and CVD is the leading cause of US deaths, proper recognition and reporting of calcification is valuable.

Should Radiology Delay the Start of Fellowships? A Survey of the APDR

RATIONALE AND OBJECTIVES

Several major medical specialties have recently considered delaying the start date of their fellowship training programs to allow for completion of their trainees' residency obligations. Radiology program directors (PDs) have voiced the need for a similar solution, as fellowship start dates at some institutions now occur well before the end of residency training. The objectives of this study are to assess the current state of the radiology fellowship transition and understand its impact on residency programs and clinical services.

MATERIALS AND METHODS

Survey Monkey (Palo Alto, CA) was used to create a survey consisting of 9 multiple choice and 2 free text questions. The survey was approved by the survey committee of the Association of Program Directors in Radiology (APDR) and distributed via email to all 240 APDR members in November 2018. The survey was closed after 30 days.

RESULTS

The response rate was 67% (160/240). Fifty-nine percent of respondents indicated some of their residents are asked to arrive at fellowships before July 1, often several days early for orientation and picture archiving and communication system (PACS) training. Sixteen percent of respondents said their own institutions ask incoming fellows to arrive early. Sixty-four percent of respondents indicated that this causes staffing problems. Seventy-eight percent of respondents supported considering a delay to the start of radiology fellowships.

CONCLUSION

Most APDR members claim that residents are asked to arrive at fellowships early to complete orientation and training before July 1, and most say that this produces staffing problems on services. A significant majority of respondents support a discussion regarding delaying fellowship start dates.

The USMLE Step 1 Pass/Fail Reporting Proposal: Another View

The Association of Program Directors in Radiology recently issued a statement endorsing continued reporting of results of the United States Medical Licensing Examination (USMLE) as a three-digit score. While this position was approved by the Association of Program Directors in Radiology Board of Directors, it does not reflect the opinions of all radiology program directors. Here, we present an argument in support of reporting USMLE results as pass/fail. As a psychometric instrument, the USMLE Step 1 is designed to assess basic science knowledge and intended to inform a binary decision on licensure. Due to a steadily-increasing burden of applications to review, program directors have increasingly relied upon scores for candidate screening. Such use has multiple adverse consequences. Student focus on Step 1 systematically devalues educational content not evaluated on the exam, and the reliance on Step 1 scores almost certainly works against efforts to increase workforce diversity. Moreover, the increasing pressure of "Step 1 Mania" has negative consequences for trainee mental health and wellness. Despite the widespread use of Step 1 scores to select applicants, there are little data to correlate scores to meaningful outcomes related to patient care or clinical practice. We find the current situation untenable, and believe a necessary first step toward reform is making Step 1 a pass/fail only examination.

A Review of Resources and Methodologies Available for Teaching and Assessing Patient-Related Communication Skills in Radiology

ACGME expectations for radiology trainees' proficiencies in communication skills pose a challenge to program directors who wish to develop curricula addressing these competencies. Numerous educational resources and pedagogical approaches have emerged to address such competencies specifically for radiology, but have yet to be systematically catalogued. In this paper, we review and compile these resources into a toolkit that will help residencies develop curricula around patient-centered communication. We describe numerous web-based resources and published models that have incorporated innovative, contemporary pedagogical techniques. In undertaking this compilation, our hope is to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.

Self-Study: Practical Tips for a Successful and Rewarding Experience

The Accreditation Council for Graduate Medical Education (ACGME) self-study is a new process for ACGME accredited radiology programs. This article serves to provide the reader with the evolution of ACGME accreditation leading to the conception of the self-study process, detail the self-study method, and offer practical advice to programs embarking upon their inaugural self-study.

Providing Feedback: Practical Skills and Strategies

Feedback is an essential component of education. It is designed to influence, reinforce, and change behaviors, concepts, and attitudes in learners. Although providing constructive feedback can be challenging, it is a learnable skill. The negative consequences of destructive feedback or lack of feedback all together are far-reaching. This article summarizes the components of constructive feedback and provides readers with tangible skills to enhance their ability to give effective feedback to learners and peers.

Conventional Medical Education and the History of Simulation in Radiology

Simulation is a promising method for improving clinician performance, enhancing team training, increasing patient safety, and preventing errors. Training scenarios to enrich medical student and resident education, and apply toward competency assessment, recertification, and credentialing are important applications of simulation in radiology. This review will describe simulation training for procedural skills, interpretive and noninterpretive skills, team-based training and crisis management, professionalism and communication skills, as well as hybrid and in situ applications of simulation training. A brief overview of current simulation equipment and software and the barriers and strategies for implementation are described. Finally, methods of measuring competency and assessment are described, so that the interested reader can successfully implement simulation training into their practice.

Perforation in a patient with stercoral colitis and diverticulosis: who did it?

Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment.