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

Preliminary investigation: Feasibility study of a virtual reality breast biopsy simulation

RATIONALE AND OBJECTIVES

Ultrasound-guided breast biopsies are the most frequently performed imaging-guided breast procedures. During training, learners may lack exposure due to limited volume and sensitive anatomy. Current simulation training often involves the use of manufactured or homemade (chicken or turkey breast) phantoms. Virtual reality is an emerging technology, allowing learners to have flexibility in learning, real-life interactive experiences and measurable feedback. The purpose of this study is to assess the feasibility of a novel virtual reality breast biopsy simulation trainer.

METHODS

This was a HIPAA-compliant, IRB-approved prospective feasibility study. The participants were three fellowship-trained breast radiologists with varying years of experience. Participants received an introduction to the virtual reality (VR) breast biopsy simulation and brief training session, describing how to enter the simulation and navigate controls. The participants were instructed to perform as many breast biopsies as possible within a 15-min time period. One biopsy cycle consisted of entering the breast with the biopsy needle, taking a biopsy sample and removing the needle. Time to successfully biopsy the mass was recorded by the VR program, and this data was recorded to assess improvement from start to finish of the simulation. A post-procedure survey was administered to all participants immediately after completion of the simulation. Qualitative open-ended subjective feedback was also obtained via Qualtrics.

RESULTS

All three breast radiologists completed the simulation. There were no complications from the procedure, including no motion sickness or fatigue resulting in simulation termination. Results of data obtained from the simulation showed decreased time to successful biopsy (slope = -19.23) with each subsequent trial for all three participant breast radiologists. A decreased time to biopsy was associated with a higher cumulative number of successful biopsies (p = 0.0037). A higher number of cumulative successful biopsies was associated with decreased number of body entries (p = 0.0332) and biopsy fires (p = 0.0221) before a successful tissue sample. Mean responses for Likert scale survey results were overall high. The radiologists found the simulator to be engaging (4.67/5.00 ± 0.47), realistic (2.67/3.00 ± 0.47) and would recommend the simulation to other healthcare professionals (2.67/3.00 ± 0.47). The radiologists participating in the trial also provided overall favorable subjective feedback.

CONCLUSIONS

This study presents a novel approach for ultrasound-guided breast biopsy training with a VR simulation that showed to be successfully capable of recording time-to-completion of each biopsy attempt. Future studies will be directed toward assessing the utility of the simulation in improving trainee skills.

The U.S. Radiologist Workforce: AJR Expert Panel Narrative Review

The U.S. radiologist workforce has experienced periods of growth as well as stagnation and downturns, with concerns of radiologist oversupply during tight job markets followed by perceived workforce shortages. Major issues facing the radiologist workforce today include the following: the impacts of accumulated policy changes; a mismatch between the demand for radiologist services and the current size of the radiologist workforce; dissatisfaction, turnover, and burnout among radiologists; challenges in radiology resident education due to employment trends; and the promise and challenges of artificial intelligence. To address current and future workforce shortages, radiology as a profession must adapt to ongoing stresses and the changing care ecosystem by promoting appropriate utilization, leveraging all existing workforce reserves, and embracing innovation. In this AJR Expert Panel Narrative Review, we explore the recent history of the U.S. radiologist workforce; examine the political, social, and educational milieus faced by current and future radiologists; and consider the effects of disruptive technology.

On-Call Radiology Resident Preliminary Report Major Discrepancies: A Meta-analysis

RATIONALE AND OBJECTIVES

Throughout their training, radiology residents frequently perform independent overnight call, with attendings overreading reports the following morning. Call shifts are a fundamental part of radiology resident training, offering independence that can improve decision-making skills and professional confidence. However, because errors have the potential to affect patient care, analysis of clinically significant errors is critical. This meta-analysis was performed to organize existing data on on-call resident preliminary report discrepancy rates and to compare rates across modalities and resident years.

MATERIALS AND METHODS

A PubMed search was performed in August 2024 using ("resident report discrepancy" OR ("resident" AND "error") OR "preliminary") AND "radiology" AND "call". Articles were included if they met the criteria, and relevant information was collected. Statistical analysis was performed.

RESULTS

The PubMed search resulted in 107 articles, of which 20 met inclusion criteria. These studies included 616,918 preliminary reports. Pooled preliminary report major discrepancy rate (%) by modality was 0.64 for radiographs, 0.38 for US, 1.35 for CT, and 1.86 for MRI and by resident year was 1.27 for R1s, 1.05 for R2s, 0.88 for R3s, and 0.67 for R4s. The highest discrepancy rate was seen for R1s reading MRI (8.70%). The majority of papers included describe residents taking independent call, with only three having fellow or attending supervised call part of the time.

CONCLUSION

Radiology residents are valuable members of the healthcare team and demonstrate high accuracy during independent call shifts. Fellow or attending real-time supervision can shorten the time to final report, and whether a hospital implements this should be decided by analyzing its individual system. This analysis is limited by variability in the classification of major discrepancies and inability to further classify data by body region scanned. In light of this, we encourage standardization in future reporting.

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.

Factors for which radiology residents choose fellowship

PURPOSE

The objective of this study is to assess factors that influence radiology residents' decision to pursue fellowship. Historically a large majority of Diagnostic Radiology (DR) residents have pursued fellowship, but with changes in the job market and the Covid-19 pandemic, this study analyzes the current trends associated with radiology fellowship choice.

MATERIALS AND METHODS

An anonymous 28-question survey was constructed based on literature review and pilot feedback from university radiology residents. The survey was distributed through APDR and to all program coordinators to be distributed to residents. Demographic information and questions related to fellowship choice were assessed. The survey was conducted through RedCap and consisted of multiple choice and sliding scale questions.

RESULTS

214 radiology residents responded, representing 4.6 % of US DR residents across 199 programs. The top fellowship choices included neuroradiology (20.5 %), musculoskeletal imaging (17.3 %), body imaging (16.8 %), and breast imaging (16.4 %). Most influential factors for fellowship selection were strong personal interest, enjoyable rotation, work hours, job security, and compensation. Least influential factors were research opportunities and specific group practice.

CONCLUSION

The decision to pursue fellowship remains almost unanimous among US DR residents. Strong personal interest, enjoyable rotations, and favorable work hours were rated as the most important factors in the decision to pursue fellowship. Neuroradiology, musculoskeletal, and body imaging remained the most popular specialties, with a notable increase in interest in breast radiology compared to literature. To attract prospective fellows, residency and fellowship programs should emphasize aforementioned factors and offer more early exposure to subspecialties during residency.

Five Years of the Musculoskeletal Radiology Fellowship Match: Trends and Perspectives

RATIONALE AND OBJECTIVES

The 2023 Match marks 5 years since the Musculoskeletal (MSK) Radiology Fellowship Match first took place in June 2019. The objective of this study is to analyze trends in the MSK Match over its 5-year course.

MATERIALS AND METHODS

Data from the National Resident Matching Program were evaluated for the number of applicants, medical school type of matched applicants, number of programs, and number of positions. Programs were grouped according to geographic region, program size, and ACGME accreditation status. These data were plotted to look for trends over time and by program characteristics.

RESULTS

There has been little variation in the number of eligible programs registering for the Match (range 80-83). The number of available positions has had a wider variation (range 204-218), and the number of applicants preferring MSK has varied from 156 to 178. The gap between positions and applicants has resulted in a percentage of positions filled that has ranged from 70.9% to 82.4%. Program size is positively correlated with Match rates, with 100% of programs with five or more positions filling ≥ 50% in 4 out of 5 years.

CONCLUSION

The variable numbers of fellowship positions and applicants have resulted in variable success of the Match by all metrics. Maintaining or increasing the number of applicants is the most critical factor for ongoing Match success.

Training the New Radiologists: Approaches for Education

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