Results of the 1996 survey of the American Association of Academic Chief Residents in Radiology

Results of the 2014 survey of the American Alliance of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

The American Alliance of Academic Chief Residents in Radiology (A³CR²) conducts an annual survey of chief residents in accredited radiology programs in North America. The survey serves as a tool for observing trends and disseminating ideas among radiology programs.

MATERIALS AND METHODS

An online survey conducted through the SurveyMonkey Web site was distributed to chief residents from 187 Accreditation Council on Graduate Medical Education (ACGME)-accredited radiology training programs. A variety of multiple-choice and free-response questions were designed to gather information about residency program details, benefits, chief resident responsibilities, call, preparations for the recent American Board of Radiology Core Examination, implementation of selectives (mini-fellowships), fellowships, health care economics and the job market, and ACGME milestones.

RESULTS

Among those surveyed, 212 unique responses from 136 programs were provided, yielding a 73% response rate. Data were compared to historical data from prior surveys dating back through 2002.

CONCLUSIONS

Programs are increasingly providing 24-hour sonographer coverage, full day routine services on weekends, and 24-hour attending radiologist coverage. The new American Board of Radiology examination format and schedule has driven many changes, including when chief residents serve, board preparation and review, and how the final year of residency training is structured. Despite facing many changes, there is slightly more optimism among chief residents regarding their future job prospects.

Results of the 2012 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVE

Every year, the American Association of Academic Chief Residents in Radiology conducts a survey of the chief residents in accredited radiology training programs in North America. The survey serves as a tool for gathering information, sharing ideas, and voicing opinions.

MATERIALS AND METHODS

An online survey was made available to the chief residents from 187 training programs in North America. Questions were presented in multiple-choice and free response formats, designed to address many issues ranging from program structure to on-call policies, changes for the new board examination format and fellowships, and the effects of health care reform on radiology practices. The results of the survey were tabulated and responses to the repeated questions were compared with those from earlier surveys dating to 2003.

RESULTS

Among those surveyed, 185 individual responses representing 135 unique programs were completed, yielding a 73% response rate. Thirty-eight percent of programs responded from the northeast and 17% of programs responded from the southeast. Nineteen percent of responses were from central United States, 14% of responses were from western United States, and 12% of responses were from Canada.

CONCLUSIONS

There is an increasing number of programs, which cover more hospitals, during the past decade. There are more programs providing ultrasound and magnetic resonance services after hours, with an associated increase in after-hours attending physician coverage. Many changes are being made for the future board examination format. Health care reform is affecting how residents are preparing themselves for their future practices.

Effect of work hours, caseload, shift type, and experience on resident call performance

RATIONALE AND OBJECTIVES

To analyze the independent effects of multiple variables on resident call performance.

MATERIALS AND METHODS

Independent radiology resident "on call" cross-sectional imaging interpretation quality assurance (QA) data obtained during a 171-day period at a single tertiary care Level 1 trauma teaching institution was reviewed. Clinically significant resident-faculty discrepancies were compared among three different call types: traditional single-day overnight call (OC, 15 hours/night after 9 daytime hours on weekdays), 7-night nightfloat (NF, 9 hours/night), and weekend day call (WD, 10 hours/day). Logistic regression analyses were performed to evaluate associations.

RESULTS

There were 119 (0.89%) clinically significant resident-faculty discordances from 13,424 cross-sectional interpretations: 56 (0.79%) from 7102 interpretations on 172 OC shifts, 39 (0.85%) from 4567 interpretations on 165 NF shifts, and 24 (1.4%) from 1755 interpretations on 49 WD shifts. Individual residents (n = 20) had a mean discrepancy rate of 0.9% (0.45%-1.9%). Overall, 102 (26.2%) of the shifts had at least one discordance. The following were associated with significantly (P < .001) increased discrepancy rates: junior vs. senior residents (odds ratio [OR] = 1.3 [1.2-1.4]), OC vs. NF (OR = 1.5 [1.3-1.6], WD vs. NF (OR = 1.4 [1.2-1.6]), weekend vs. weekday (OR = 1.3 [1.2-1.4]), and increasing cases/hour (OR = 1.6 [1.5-1.7]). Weekend OC shifts had a higher discrepancy rate (OR 1.3[1.2-1.5], P < .001) than weekday OC shifts despite a shorter workday (15 vs. 24 hours).

CONCLUSION

Increasing caseload, junior residents, and weekends are associated with a significantly higher discrepancy rate. OC is associated with a significantly higher discrepancy rate than NF. Measured discrepancy rates are low, regardless of call type.

Effects of a professional liability crisis on residents' practice decisions

OBJECTIVE

Pennsylvania, like many states, is in a professional liability crisis characterized by escalating cost and decreasing availability of liability insurance. Medical and surgical specialists have experienced especially large increases in insurance premiums. The objective of this study was to estimate the impact of liability concerns during a professional liability crisis on Pennsylvania residents' decisions regarding their future practice. It was hypothesized that liability concerns would negatively affect Pennsylvania residents' propensity to practice in the state following residency.

METHODS

Statewide mail surveys were completed in 2003 by 68 Pennsylvania residency program directors and 360 residents nearing the end of their training in anesthesiology, general surgery, emergency medicine, obstetrics and gynecology, orthopedics, and radiology residencies.

RESULTS

One third of residents in their final or next-to-last year of residency planned to leave Pennsylvania because of the lack of availability of affordable malpractice coverage. Although, in general, residents' geographic decisions are influenced by a range of factors, those who are about to leave Pennsylvania named malpractice costs as the primary reason 3 times more often than any other factor. Seventy-one percent of residency program directors reported a decrease in retention of residents in the state since the onset of the professional liability crisis. For some programs the decreases were very large.

CONCLUSION

An environment of mounting liability costs in Pennsylvania appears to have dissuaded substantial numbers of residents in high-risk specialties from locating their clinical practices in the state. The impact of decreased resident retention on the future availability of specialist services in high-cost states merits close monitoring.

Implementing resident work hour limitations: lessons from the New York State experience

OBJECTIVE

To determine the impact of work hour limitations imposed by the 405 (Bell) Regulations as perceived by general surgery residents in New York State.

SUMMARY BACKGROUND DATA

New Accreditation Council for Graduate Medical Education (ACGME) requirements on resident duty hours are scheduled to undergo nationwide implementation in July 2003. State regulations stipulating similar resident work hour limitations have already been enacted in New York.

METHODS

A statewide survey of residents enrolled in general surgery residencies in New York was administered.

RESULTS

Most respondents reported general compliance with 405 Regulations in their residency programs, a finding corroborated by reported work hours and call schedules. Whereas a majority of residents reported improved quality of life as a result of the work hour limitations, a substantial portion reported negative impacts on surgical training and quality and continuity of patient care. Negative perceptions of the impact of duty hour restrictions were more prevalent among senior residents and residents at academic medical centers than among junior residents and residents at community hospitals.

CONCLUSIONS

Implementation of resident work hour limitations in general surgery residencies may have negative consequences for patient care and resident education. As surgical residency programs develop strategies for complying with ACGME requirements, these negative consequences must be addressed.

Results of and comments on the 2000 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

The American Association of Academic Chief Residents in Radiology (A3CR2) annually surveys radiology residency programs on issues related to training. The objective is to highlight national similarities, differences, and trends to help programs establish standards and improve residency training.

MATERIALS AND METHODS

Questionnaires were mailed to 180 accredited diagnostic radiology residency training programs in the United States. The survey covered the usual general topics and more specific topics considered every 4 years; for 2000 the latter were on-call issues and the chief residency year.

RESULTS

Completed surveys were returned from 63 programs (35%). Important findings included increased caseload and call commitments, especially for smaller programs. Resident salaries appear to have increased more than the consumer price index. Nonemergent after-hour coverage and teleradiology are now a large part of the resident work practice. Women continue to be underrepresented, with a trend downward. Chief residents are more involved in organizing preparation for board examinations and have greater office facilities and more administrative duties.

CONCLUSION

This survey provided useful insights. All levels of residency face increased workloads. On-call hours have not changed, but the work has intensified and the use of teleradiology has increased. Many programs have adopted a "night-float" system, and nonemergent after-hours coverage should be considered in any program evaluation. Continued vigilance and sustained efforts are required to ensure that radiology is considered as a specialty by both men and women. With increased demands on attending physicians' time, chief residents may need to take on more administrative responsibilities.

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.

Results of the 1997 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

The American Association of Academic Chief Residents in Radiology annually surveys residency programs on a variety of issues related to residency training. The survey results allow individual programs to compare features of their programs with national averages and to gauge trends in radiology residency training.

MATERIALS AND METHODS

Questionnaires were mailed to the chief residents in 180 accredited radiology residency programs in the United States. A variety of demographic and common-interest questions were asked. The 1997 survey focused on American Board of Radiology (ABR) examination preparation, residency curriculum, and socioeconomic issues relevant to graduating radiology residents.

RESULTS

Completed surveys from 73 programs (41%) were returned. Areas of curriculum concern among chief residents reflected primarily current turf issues. A higher than expected percentage of residents considered their training to be inadequate in nonneurologic magnetic resonance imaging and chest, musculoskeletal, and genitourinary radiology. Job security is a major emerging concern for radiology residents who are considering careers in private practice. The practice of remembering and transcribing questions from the ABR written examination is common, and these questions are a valued resource in preparing for the diagnostic section of the written examination. Most residents attend a commercial review course before the oral examination, and the majority of programs also provide internal review courses.

CONCLUSION

A higher than expected percentage of chief residents expressed concern regarding training in subspecialties of radiology that are neither areas of turf dispute nor areas where certificate of additional qualification examinations are offered. Radiology programs and residents expend substantial resources on preparation for the ABR examinations in addition to the usual 4-year curriculum. The most valued resource for the diagnostic section of the examination is almost certainly not equally available. Radiology residents are increasingly concerned about future job security.