A survey evaluating the beliefs of radiology residency program directors regarding incorporation of numeric standards into accreditation standards

RATIONALE AND OBJECTIVES: Numeric standards do not exist for the evaluation and comparison of radiology resident education. The Accreditation Council for Graduate Medical Education has recently proposed the evaluation and assessment of residents by using numeric values for films read in various radiology modalities. The purpose of this study was to evaluate radiology residency program directors' perceived need for numeric standards for radiology residency programs. MATERIALS AND METHODS: Program directors were surveyed via a three-part questionnaire. Initial contact was made by e-mail, with follow-up by telephone if necessary. The survey questions were: (1) Do you feel that a need exists for a set of numerical standards for the number of films read by radiology residents in each of the various subspecialties? (2) Specify the needs that you see. (3) What are the barriers and disadvantages to acquiring such data? RESULTS: Survey responses were received from 44 of 192 radiology residency programs (23% response rate). Overall, 34 (77%) of 44 program directors were against implementation of the Accreditation Council for Graduate Medical Education proposal, whereas 8 (18%) of 44 program directors were in favor of the proposal and 2 (5%) of 44 were undecided. A variety of reasons, both for and against the proposal, were provided by program directors. CONCLUSION: Among the program directors responding to the survey, there was strong opposition to implementation of mandatory standards for specific numbers of radiologic examinations by residents as the basis for program accreditation.     

The association of departmental leadership gender with that of faculty and residents in radiology

RATIONALE AND OBJECTIVES: Although the number of women graduating from medical school continues to increase, their representation in radiology residency programs has not increased over the past 10 years. We examined whether the gender of radiology faculty and residents differed according to the gender of the departmental leadership. MATERIALS AND METHODS: We issued an anonymous Web-based survey via e-mail to all 188 radiology residency program directors listed in the Fellowship and Residency Electronic Interactive Database (FREIDA Online). Data regarding the gender of the department chairperson, residency program director, faculty, and residents were collected. The institutional review board granted a waiver for this study, and all subjects provided informed consent. RESULTS: Of the 84 program directors who responded, 9 (10.7%) were chaired by females and 75 (89.3%) by males; residency program director positions were held by 36 (42.9%) females and 48 (57.1%) males. More programs were located in the northeastern United States (n = 31, 36.9%) than in any other region, and more were self-described as academic (n = 36, 42.9%) than any other practice type. Programs that were led by a male chairperson had a similar proportion of female faculty (25.2% versus 27.3%; P = .322) and residents (26.2% versus 27.4%; P = .065) compared with those led by a female. Similarly, radiology departments with a male residency program director had a similar proportion of female residents (24.8% versus 28.7%; P = .055) compared with programs with a female residency program director. CONCLUSION: The gender composition of radiology faculty and residents does not differ significantly according to the gender of the departmental chairperson or residency program director. Nevertheless, there continues to be a disparity in the representation of women among radiology faculty and residents.     

Diagnostic radiology resident compliance with recommended health guidelines: effect of resident work environment

RATIONALE AND OBJECTIVES: To determine diagnostic radiology resident compliance with recommended health guidelines for physical activity, body weight, diet, related health indicators, and the effects of the resident work environment on compliance. MATERIALS AND METHODS: A request was electronically mailed to members of the Association of Program Directors in Radiology and the Association of Program Coordinators in Radiology in May 2007 and again in June 2007, asking members to forward to their radiology residents an invitation to complete an online health survey. Frequency counts and Fisher's exact test, respectively, were used to summarize results and to determine statistically significant relationships between survey variables. RESULTS: A total of 811 radiology residents completed the survey, representing 18% of 4,412 diagnostic radiology residents. Five hundred forty-five (67.2%) of 811 were male and 264 (32.6%) female. Two hundred ten (25.9%) were first-year, 239 (29.5%) second-year, 201 (24.8%) third-year, and 161 (19.9%) fourth-year residents. Three hundred two (37.2%) engaged in recommended guidelines for physical activity and < or =465 (57.3%) complied with each of multiple federal dietary guidelines (excluding alcohol intake). Up to 329 (40.6%) residents did not know whether they were in compliance with various dietary guidelines. A total of 426 (52.5%) residents reported working > or =60 hours/week, which significantly correlated with less physical activity (P = .013). CONCLUSION: A substantial number of residents are out of compliance with federal guidelines for physical activity and diet and are not knowledgeable about their personal dietary intake. Long work hours are related to a lack of physical activity. Radiology programs may be able to influence resident health practices by modifying work hours and the working environment, encouraging healthy dietary intake and physical activity, and instituting campaigns to inform residents and faculty about health guidelines and available wellness programs.     

Evaluation of an online faculty appraisal instrument: comparison of resident and faculty perceptions

RATIONALE AND OBJECTIVES: Our purpose was to compare faculty and resident perceptions regarding an online faculty appraisal instrument and the potential impact of the appraisal process. MATERIALS AND METHODS: Faculty members and residents at an academic medical center diagnostic radiology department were asked to complete anonymous surveys that sought feedback regarding an online faculty appraisal form and process. Questions were asked regarding the relative importance of various faculty performance measures, preferences for narrative versus quantitative components of the instrument, and the likely impact of the evaluation process on future faculty behavior. RESULTS: The survey was completed by 19 (45%) of 42 faculty members and by 16 (80%) of 20 residents who participated in the initial faculty appraisal process. Residents and faculty both assigned generally high rankings to the six measures of faculty performance. The vast majority (86 %) of faculty and residents found the narrative component of the survey (either alone or in combination with quantitative data) most helpful. Based on the appraisal process, 74% of the faculty planned to modify one or two aspects of their behavior, whereas a significant minority (44%) of residents thought that the faculty would not make any changes. CONCLUSION: Faculty and residents generally agree on a core set of faculty performance measures, and both groups show a preference for an appraisal instrument that incorporates a narrative component. Concerning the perceived impact of the appraisal process, faculty members were slightly more optimistic than residents regarding its ability to serve as an impetus for faculty behavioral changes.     

Call obligations in radiology residency: a survey

RATIONALE AND OBJECTIVES: The authors evaluated the initial assignment of call responsibilities during residency, the effect on call obligations of the number of residents, and the differences between private and university programs and level 1 and non-level 1 trauma centers. MATERIALS AND METHODS: A survey was sent to all 203 diagnostic radiology residency programs accredited by the Accreditation Council for Graduate Medical Education. Chief residents at 21 institutions were surveyed by phone or in person. Directors of residency programs in the Graduate Medical Education Directory received the survey electronically. RESULTS: Responses were received from 99 (68 university, 31 private practice) of the 203 programs. Nine (9%) reported both a decreased number of residents and a subsequent increase in call obligations. First-year residents generally began to accept calls with a senior resident or alone at a median of 6 months, although 15 (48%) private practice programs required them to accept calls alone before this time. First-year residents at university programs (31%) were more likely to assume call duties during the first 6 months accompanied by a senior resident. Maximum time before 1st-year residents started going on call was 13 months. CONCLUSION: Call obligations remain a resident responsibility. University and private practice programs differ more than level 1 and non-level 1 trauma centers.     

Junior faculty satisfaction in a large academic radiology department

RATIONALE AND OBJECTIVES: Retention of academic faculty is a pressing issue for many radiology departments. The departure of junior faculty members to private practice may be driven in part by economics; however, the choice may be influenced by many other elements of faculty satisfaction. The purpose of this study was to evaluate how satisfied junior (assistant professors and instructors) and senior (associate professors and professors) faculty in an academic radiology department are with respect to their work and to determine which factors most affected the decision to stay in academics. MATERIALS AND METHODS: We conducted a survey of junior and senior faculty in the department of radiology. Questions included attitudes regarding work, home, and family issues. Among the 27 junior faculty (73%) who responded to the survey, 14 were instructors and 13 were assistant professors. Among the 11 senior faculty (21%) who responded to the survey, 3 were associate professors and 8 were professors. RESULTS: Academic radiology faculty are very happy with work and derive enjoyment and fulfillment from their work. The working week excluding call (average 52 hours) and including call (average 61 hours) was not regarded as too long. The average academic faculty works 72% clinical time (range 15% to 100%) and gets 0.96 day a week of professional development. Fifty-nine percent are funded at an average of 0.91 day a week. Forty-one percent are on tenure track, and of the remainder, 40% expressed a desire for tenure track. Fifty-five percent of faculty have mentors and 57% receive adequate mentoring. When it comes to teaching, 50% have enough time to teach juniors. Of the remainder, all but one cited high clinical workload as an impediment to teaching juniors. Forty-one percent of faculty reported not getting enough academic time. Fifty-nine percent felt pressure to publish and 34% felt pressure to obtain external funding. Seventy-six percent surveyed felt it has become more difficult to publish. The main reasons cited were increasing clinical workload (34%), higher standards required (25%), lack of academic time (25%), and institutional review board constraints (16%). Twenty-eight percent of faculty work on research projects during weekends, 25% during professional development time, and 21% on weekday evenings. However, 63% said they had too little time to spend at home, with family, or on hobbies. The main reasons cited were demands on time caused by clinical work (45%), research (42%), and teaching (24%). Fifty-three percent said that their work regularly causes conflicts at home. CONCLUSIONS: The main reasons to stay in academics were the opportunity for teaching (68%), working with expert colleagues (58%), to pursue research (55%), and an interesting mix of cases (47%). Disincentives to stay in academics included insufficient financial remuneration (82%), the high clinical workload (45%), academic center "politics," and the lack of academic time (42%).     

Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES: Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS: The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS: Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION: A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.     

Online radiology appropriateness survey: results and conclusions from an academic internal medicine residency

RATIONALE AND OBJECTIVES: This study was performed to evaluate the ability of medical trainees to choose appropriate diagnostic imaging studies for patients with various clinical indications. MATERIALS AND METHODS: Twelve clinical scenarios were excerpted from the 2000 edition of the American College of Radiology appropriateness criteria and arranged in multiple-choice question format. Summary answers based on the criteria were written. The questionnaire and answer key were placed online and linked; the answer key was viewable only after all 12 answers were submitted by the trainee. An invitation to participate in the online survey was forwarded to medical house staff. RESULTS: Sixty-five (43.3%) of 150 potential respondents completed the survey. The results were tabulated for all respondents and separately for each postgraduate-year class. Fewer than 50% of the respondents correctly answered more than half of the 12 questions. The average number of questions answered correctly by 1st-year residents was 7.02; by 2nd-year residents, 7.5; and by 3rd-year residents, 7.9. CONCLUSION: Medical house staff are not adequately prepared to choose appropriate imaging examinations for specific indications. Improvements in education could prevent inappropriate use of radiology resources. Imaging centers might want to consider developing online catalogs to assist clinicians in choosing appropriate imaging tests.     

Part I: preparing first-year radiology residents and assessing their readiness for on-call responsibilities

RATIONALE AND OBJECTIVES: The aim of the study is to evaluate the effectiveness of an Emergency Radiology (ER) Core Curriculum training module and a Digital Imaging and Communications in Medicine (DICOM)-based interactive examination system to prepare first-year (postgraduate year 2 [PGY-2]) radiology residents and assess their readiness for taking overnight radiology call. MATERIALS AND METHODS: Institutional review board approval was obtained, and the study was compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations. A dedicated month-long ER curriculum was designed to prepare new radiology residents for overnight radiology call that includes interpretation of off-hour urgent and emergent studies without immediate direct attending supervision. Lectures of the curriculum, provided by department staff, were based on the American Society of Emergency Radiology core curriculum. The lecture series was implemented after PGY-2 residents had completed formal introductory resident rotations during their first 6 months of training. A DICOM-based interactive computer-based testing module was developed and administered at the end of the lecture series. The module consisted of 19 actual emergency department cases with entire series of images, simulating an on-call setting. Tests were scored by two staff members blinded to resident identifying information. Upper-level residents also were tested, and comparison was made between first-year and upper-level resident test scores to determine the effectiveness of the test in determining first-year resident preparedness for call. Statistical analysis of results was performed by using t-test (P < .05). RESULTS: All residents in the residency program present during the month (nine PGY-2, six PGY-3, seven PGY-4, seven PGY-5 residents) attended the lecture series and finished the testing module at the end of the lecture series. Of 19 actual emergency cases on the testing module, five cases were neuroradiology, three cases were thoracic imaging, eight cases were body imaging, and three cases were musculoskeletal. PGY-2 residents scored an average of 73.0% (range, 63.2%-81.6%) of total points possible. PGY-3 residents scored an average of 76.8% (range, 68.4%-86.8%); PGY-4 residents scored an average of 77.4% (range, 65.8%-100%), and PGY-5 residents scored an average of 81.2% (range, 68.4%-94.7%). There was no statistically significant difference in scores according to level of training. CONCLUSION: First-year radiology residents who underwent 6 months of formal radiology training followed by an intensive ER lecture series before taking overnight call had scores similar to upper-level colleagues on an interactive computer-based ER simulation module.     

Methods and resources for physics education in radiology residency programs: survey results

Over the past 2 years, ongoing efforts have been made to reevaluate and restructure the way physics education is provided to radiology residents. Program directors and faculty from North American radiology residency programs were surveyed about how physics is being taught and what resources are currently being used for their residents. Substantial needs were identified for additional educational resources in physics, better integration of physics into clinical training, and a standardized physics curriculum closely linked to the initial certification examination of the American Board of Radiology.     

Evaluation of clinical experience in a radiology residency program with quantitative profiling: rationale,methods, and application

RATIONALE AND OBJECTIVES: The author developed a technique for residency program evaluation, called "quantitative profiling," that is based on computer retrieval of radiologic reports. The hypothesis was that it would provide insights into the contributions of residents to clinical service, measures of resident experience and productivity for program evaluation, and benchmarks for comparison. MATERIALS AND METHODS: The radiology residency program of a major teaching hospital was studied retrospectively from 1989 to 1997. The number of radiologic reports signed by individual residents and faculty members was retrieved. The clinical experience of the 1993-1997 cohort of residents was described according to subspecialty area and modality. RESULTS: Residents signed 46.5% of all reports, with a mean total of 14,445 reports +/- 1,292 per resident during the entire residency. The distribution of examinations was as follows: thoracic, 42.1%; musculoskeletal, 26.1%; abdominal, 13.4%; sonography, 8.7%; neuroradiology, 4.3%; nuclear, 2.4%; breast, 1.6%; and vascular, 1.4%. The most frequently reported results were for one-view chest radiography. CONCLUSION: Quantitative profiling can help track the range and progress of resident experience, help determine the deployment of residents, and provide empirical data upon which decisions to modify residency programs may be based.     

Evidence-based practice in radiology: Knowledge,attitude and perceived barriers to practice among residents in radiology

Aim

We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology.

Study design and setting

We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course.

Results

Eighty (83.3%) residents, 55 male and 25 female of age range 24–34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p < 0.0001).Attitude of collegues (p = 0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p = 0.02) and a greater awareness of sources for seeking evidence based literature (p = 0.05) held stronger beliefs that EBPR significantly improved patient care.

Conclusions

The large knowledge gap related to EBPR suggests the need to incorporate structured training into the core-curriculum of training programmes in radiology.     

臂丛的扩散加权MR神经成像：可行性研究

这项研究得到了大学医学中心乌得勒支（荷兰）机构审查委员会的批准和所有受检者签署知情同意书。这项研究的目的是介绍和评估臂丛的扩散加权MR神经成像。扩散加权的神经成像要通过最大强度投影技术来显示。扩散加权的神经成像对5名健康志愿者和5例病人进行评估。在扩散加权MR神经成像中，健康志愿者的臂丛表现为长条形的轨线。     

Current trends and perspectives in interventional radiology for gastrointestinal cancers

Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.