Differences in Neuroradiology Training Programs around the World

BACKGROUND AND PURPOSE:No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites.MATERIALS AND METHODS:Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies.RESULTS:While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%).CONCLUSIONS:There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally.

The United States considers itself a leader in medical education and training among nations.¹ Generally speaking, American medical school, residency, and fellowship programs are considered globally as being well-structured, highly competitive, and outstanding in the quality of education and instruction. As of the 2013–2014 academic year, 185 radiology residency programs and 85 neuroradiology (NR) fellowship programs in the United States are voluntarily supervised by the Accreditation Council for Graduate Medical Education (ACGME). This private, nonprofit organization sets educational standards and periodically reviews their implementation within the respective graduate medical education programs.² In addition, completion of programs accredited by the ACGME is a prerequisite to becoming board-certified in diagnostic radiology and subspecialty certified in neuroradiology. Examinations are offered by the American Board of Radiology annually through the American Board of Medical Specialties. It oversees specialty and subspecialty certification in radiology and 23 other medical specialties in the United States.The educational path for an aspiring American neuroradiologist typically begins by matching in a first-postgraduate-year prerequisite clinical year (internship year) and an ACGME-accredited postgraduate year 2- to 5-year diagnostic radiology residency program.³ The first 3 years of residency focus on diagnostic radiology (postgraduate years 2–4) and include 9 core rotations in abdominal radiology, breast imaging, cardiothoracic radiology, musculoskeletal radiology, neuroradiology, nuclear radiology, pediatric radiology, sonography, and vascular and interventional radiology. In postgraduate year 5, residents may participate in subspecialty rotations of their choice.⁴ The trainees'' diagnostic experience in the different imaging modalities is assessed through a case/procedure log system, which is annually reviewed by the faculty of the program and the ACGME.⁵After finishing residency, graduating radiologists have the opportunity to start additional fellowship training within their discipline of choice if they desire subspecialty expertise.⁶ Contributing factors that promote the implementation of fellowship programs in radiology are the rapid development of new imaging techniques, the need for appropriate interpretation skills and expertise to compete in the job market, and the trend toward endovascular and percutaneous therapies.¹The first NR fellowship positions were offered in Stockholm and London in the 1950s and approximately 10 years later in New York (1960).⁷ Regarding neuroradiology, 2 fellowships are offered in the United States currently: diagnostic neuroradiology (DNR) and interventional neuroradiology (INR), with the latter, by ACGME regulations, requiring a previous DNR year. However, very few of the offered neurointerventional programs are currently ACGME-accredited, so this requirement is often not completed.Because there is a trend toward greater subspecialization in radiology globally, we conducted a survey to investigate differences in radiology training programs across the world with regard to the general curriculum, focusing on neuroradiology fellowships in particular. Therefore, departments in countries on all continents were asked to complete a standardized questionnaire about their training programs. Hence, differences in international educational structures could be revealed.     

Endovascular interventional neuroradiologic procedures: who is performing them, how often, and where? A survey of academic and nonacademic radiology practices

BACKGROUND AND PURPOSE: In this report, the authors assess practice patterns at both academic and nonacademic centers regarding the treatment of aneurysms with Guglielmi detachable coils (GDCs), thrombolysis of the carotid-vertebral arteries, and stent placement with angioplasty of the carotid arteries. METHODS: A neurovascular radiology survey was sent to 102 directors of neuroradiology fellowship programs in the United States and Canada ("academic centers"). The survey was also sent to senior members of the American Society of Neuroradiology (three per state) who were not affiliated with fellowship programs ("nonacademic centers"). RESULTS: Fifty-seven surveys from academic practices and 70 surveys from nonacademic practices were returned. A total of 4361 procedures (2283 GDC; 949 thrombolysis; 1129 stent placement) were performed; 84% were performed at academic centers and 16% at nonacademic centers. Ninety percent of GDC, 71% of thrombolysis, and 82% of stent placement procedures were performed at academic centers. Seven academic and three nonacademic centers performed 48% of all GDC procedures; eight academic and four nonacademic centers performed 45% of all thrombolysis procedures; eight academic centers performed 50% of all stent placement procedures. A total of 544/4361 (12%) procedures were performed by nonradiologists. At academic centers, 14% of procedures were performed by nonradiologists; participation by nonradiologists was greatest for carotid stent placement (24% of procedures). At nonacademic centers, only 5% of procedures were performed by nonradiologists. CONCLUSION: According to this survey, most endovascular interventional neuroradiologic procedures are performed at academic centers; given the survey population, this study likely identifies the lower limit of participation by nonradiologists (12%). Performance of these procedures is concentrated in relatively few centers, and these data raise questions about the overall use of intraarterial thrombolytic therapy for acute infarction.     

Assessment of the neuroradiology fellowship match: year 3

BACKGROUND AND PURPOSE: When the fellowship match for trainees entering neuroradiology programs was first proposed in 2001, the program directors in neuroradiology agreed to a 3-year trial utilizing the National Residency Match Program (NRMP) for selecting fellows. A decision as to whether to continue with the neuroradiology fellowship match was to be assessed at the 3-year mark in 2004. METHODS: A Web survey designed through the offices of the ASNR was distributed to neuroradiology fellowship program directors after the results of the most recent fellowship match were tabulated in June 2003. The questionnaire included items about the current sentiment about the fellowship selection process. RESULTS: Most (52 of 61 = 85%) neuroradiology program directors favored continuing the match system for selecting fellows. Most believed that the match 1) had little impact on their success in recruiting fellows (43 of 62 = 69%), 2) was fairly administered (100%), and 3) was appropriately timed from February to June in the third year of residency (56 of 65 = 86%). The number of candidates entering the neuroradiology match increased from 71 in 2001 to 124 in 2003. CONCLUSION: Support for continuing a match system for selecting fellows remains high (85%) among neuroradiology program directors. The system is considered fair and does not harm many programs. The recruitment of fellows to neuroradiology via the match has increased over the 3 years of its existence.     

Fellowship Candidate Factors Considered by Program Directors

ObjectiveThe neuroradiology fellowship match has been in existence for about 20 years. However, the elements by which neuroradiology fellowship program directors evaluate candidates have not been clearly elucidated. We sought to identify the factors that program directors use to rank neuroradiology fellowship applicants.MethodsAn anonymous Qualtrics online five-question survey about educational credentials, personal traits, extracurricular activities, and demographic characteristics was sent to 72 neuroradiology program directors in April 2019. Each question required ranking of 10 factors based on different characteristics of fellowship candidates. Items included gender, nationality, US Medical Licensing Examination scores, internal applicants, work and research experience, recommendation letters, residency program, medical school attended, and visa status. Program directors had the ability to list any new characteristics that were not included in the survey.ResultsIn all, 68 of 72 (94.4%) neuroradiology programs responded to the survey. The most important criteria by which candidates were assessed were (1) residency program attended for educational credential, (2) personality as assessed by faculty at interviews for candidate personal traits, (3) research performed for candidate’s extracurricular activities, and (4) likelihood of coming to or previous experience in the fellowship geographic area. Neuroradiology program directors independently stressed residency program attended, personality assessed during the interview by faculty, internal candidate status, letters of recommendation, and research activities as their top five criteria in ranking the candidates.ConclusionMultiple factors are weighed by neuroradiology fellowship program directors in selecting fellows, but recent experiences in residency, research, and faculty interactions are prioritized. Internal candidates have an advantage for remaining as fellows within their residency programs.     

<p>Postgraduate musculoskeletal fellowship training in the United States: current trends and future direction

OBJECTIVE: To document current postgraduate musculoskeletal training program (accredited and unaccredited) curricula and approaches to education. DESIGN AND PATIENTS: Questionnaires were sent to all musculoskeletal training programs. Responses regarding radiology residency and fellowship program sizes, types of imaging and invasive procedures included, and other program parameters were solicited. Features of accredited and unaccredited programs were compared. Teaching approaches, including the use of web-based or distance learning were evaluated. RESULTS: Twenty-nine (73%) of 40 musculoskeletal programs responded to the questionnaire. Twenty-eight percent of programs were accredited and 72% unaccredited. Radiology residencies were also present at all responding institutions (the majority had a class size of 4-8/year). Residency programs in related specialties included pathology 96%, orthopedics and rheumatology 90%, oncology 83% and pain management 69%. The majority (93-100%) provided training in radiography, MRI and CT. Spine MRI was included in 69% of programs, ultrasonography in 62% and positron emission tomography in 24%. Arthrography and diagnostic and therapeutic injections (100%) were included in all programs. Other invasive procedures, including spine and radiofrequency ablation, were offered less frequently. Teaching approaches included conferences (100%), journal clubs (62%), multidisciplinary conferences (45-90%), web-based learning (30%) and distance learning (7%). Forty-one percent of programs offered off-site rotations. CONCLUSIONS: The majority of musculoskeletal training programs prepared trainees for private or academic practice. There are inconsistencies that could be improved to better prepare trainees for careers in musculoskeletal imaging.     

Program requirements for residency/fellowship education in neuroendovascular surgery/interventional neuroradiology: a special report on graduate medical education

BACKGROUND AND PURPOSE: Neuroendovascular surgery/interventional neuroradiology is a relatively new subspecialty that has been evolving since the mid-1970s. During the past 2 decades, significant advances have been made in this field of minimally invasive therapy for the treatment of intracranial cerebral aneurysms; acute stroke therapy intervention; cerebral arteriovenous malformations; carotid cavernous sinus fistulas; head, neck, and spinal cord vascular lesions; and other complex cerebrovascular diseases. Advanced postresidency fellowship programs have now been established in North America, Europe, and Japan, specifically for training in this new subspecialty. METHODS: From 1986 to the present, an ad hoc committee of senior executive committee members from the American Society of Interventional and Therapeutic Neuroradiology, the Joint Section of Cerebrovascular Neurosurgery, and the American Society of Neuroradiology met to establish, by consensus, general guidelines for training physicians in this field. RESULTS: In April 1999, the Executive Committee of the Joint Section of Cerebrovascular Neurosurgery voted unanimously to endorse these training standard guidelines. In May 1999, the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology also unanimously voted to endorse these guidelines. In June 1999, the Executive Council of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons unanimously voted to endorse these guidelines. CONCLUSION: The following guidelines for residency/fellowship education have now been endorsed by the parent organization of both the interventional and diagnostic neuroradiology community, as well as both senior organizations representing neurosurgery in North America. These guidelines for training should be used as a reference and guide to any institution establishing a training program in neuroendovascular surgery/interventional neuroradiology.     

Diagnostic radiology residents in the classes of 1999 and 2000: fellowship and employment

OBJECTIVE: Most diagnostic radiology residents undergo fellowship training. Applications for fellowship positions are submitted during the third year of residency. We compared the number of residents undertaking fellowship, accepting jobs, and rescinding accepted fellowship positions to accept jobs. MATERIALS AND METHODS: During the 47th Association of University Radiologists meeting, participants from the American Association of Academic Chief Residents in Radiology completed a questionnaire regarding the intentions of third- and fourth-year residents in their programs. RESULTS: Seventy programs, representing 402 fourth-year and 395 third-year residents, responded. Of fourth-year residents, 322 (80.1%) accepted fellowships and 41 (10.2%) accepted jobs. Of third-year residents, 335 (84.8%) accepted fellowships. Eighty-eight (27.3%) fourth-year residents and 95 third-year residents (28.4%) accepted interventional radiology fellowships, and 104 (32.3%) fourth-year residents and 96 (28.7%) third-year residents accepted body imaging fellowships. Most residents who accepted fellowships did so in the same city in which they completed their residency training. Of fourth-year residents who accepted fellowship positions the year before, 14 (4.3%) withdrew their acceptance to pursue employment. CONCLUSION: Most residents opt for fellowship training in interventional radiology or body imaging. We postulate that the practice of accepting fellowships during the third year of residency may contribute to the percentage of residents who rescind fellowship acceptance to pursue employment. We suggest that consideration be given to changing this practice.     

Trends in Radiology Fellowship Training: A Canadian Review 2009-2011

Purpose

To assess the percentage, type, and location of radiology fellowships chosen by graduating Canadian residents between 2009 and 2011.

Methods

A short e-mail questionnaire was sent to the radiology program directors at all 16 institutions in Canada that provide English or French residency. The responses were collected between December 6, 2010, and May 20, 2011.

Results

A 75% response rate was observed for the survey: 76%–79% residents were enrolled in radiology fellowship training. In 2009–2010, 72%–73% of residents remained in Canada. This dropped to 51% in 2011. In 2009–2010, 22%–23% of residents chose U.S.-based radiology training. This rose to 49% in 2011. Europe was chosen by 0%–4% of residents: all of whom were French-speaking residents, and all programs were in France. Relatively consistent percentages of radiology residents choose abdominal (19%–30%), cardiac (4%–7%), musculoskeletal (12%–20%), and pediatrics (2%–5%) from year to year. Greater variability was noted in chest (2%–9%), women's imaging (0%–14%), intervention radiology (6%–18%), and neuroradiology (2%–18%). Radiology fellowships in split subspecialties, which were available at a small number of institutions, were chosen by 8%–9% of the residents.

Conclusions

Nearly 4 of 5 residents choose radiology fellowship training. In 2011, there was a 2-fold increase in the number of residents who chose training in the United States. This may be a 1-year outlier but should be observed. A wide range of fellowships were chosen, with consistent numbers in some core fellowships and variability in others year to year. Limited exploration of the rationale for, or employability value of, radiology fellowship choices has been done in Canada. Nearly 1 of 10 residents chose split radiology fellowships, an option limited by availability at few centers. The value of expanding this option is worthy of investigation.     

Non-interventional Radiology Fellowship Programs: What Is Out There?

ObjectiveTo determine the spectrum of non-interventional radiology fellowship programs in institutions that offer both a radiology residency program and one or more non-interventional radiology fellowship programs.MethodsInstitutions offering both radiology residency and non-interventional radiology fellowship programs were identified using publicly available websites. The non-interventional radiology fellowship programs were categorized into “traditional” (neuroradiology, breast imaging, abdominal imaging, musculoskeletal imaging, thoracic imaging, pediatric radiology, and nuclear medicine) and “nontraditional” fellowship programs. The nontraditional programs were stratified into four categories: a) Combinations of traditional fellowships; b) Focused nontraditional fellowships; c) Combinations of traditional and focused nontraditional fellowships (excluding traditional-traditional combinations); and d) Mandatory two-year fellowships. The distributions of the different types of traditional and nontraditional fellowship programs were evaluated.Results555 fellowship programs were identified in 113 institutions that offered both radiology residency and non-interventional radiology fellowship programs. 73.33% (407/555) of the programs were traditional fellowships, and 26.66% (148/555) were nontraditional fellowships. The 148 nontraditional fellowship programs were comprised of 41 different types of programs, 23 types of which were unique to and offered exclusively at specific institutions. 38.08% of the traditional fellowship programs were Accreditation Council for Graduate Medical Education (ACGME) accredited, while only 16.21% (24/148) of the nontraditional fellowship programs were ACGME-accredited.ConclusionsThe nontraditional non-interventional radiology fellowship programs are formed by a heterogeneous group of programs, some of which are offered exclusively at a single institution. Awareness of the types of existing programs would help radiology residents in making a more informed decision regarding their fellowship training.     

Am I Ready to Be an Independent Neuroradiologist? Objective Trends in Neuroradiology Fellows' Performance during the Fellowship Year

BACKGROUND AND PURPOSE:Aside from basic Accreditation Council for Graduate Medical Education guidelines, few metrics are in place to monitor fellows'' progress. The purpose of this study was to determine objective trends in neuroradiology fellowship training on-call performance during an academic year.MATERIALS AND METHODS:We retrospectively reviewed the number of cross-sectional neuroimaging studies dictated with complete reports by neuroradiology fellows during independent call. Monthly trends in total call cases, report turnaround times, relationships between volume and report turnaround times, and words addended to preliminary reports by attending neuroradiologists were evaluated with regression models. Monthly variation in frequencies of call-discrepancy macros were assessed via χ² tests. Changes in frequencies of specific macro use between fellowship semesters were assessed via serial 2-sample tests of proportions.RESULTS:From 2012 to 2017, for 29 fellows, monthly median report turnaround times significantly decreased during the academic year: July (first month) = 79 minutes (95% CI, 71–86 minutes) and June (12th month) = 55 minutes (95% CI, 52–60 minutes; P value = .023). Monthly report turnaround times were inversely correlated with total volumes for CT (r = –0.70, F = 9.639, P value = .011) but not MR imaging. Words addended to preliminary reports, a surrogate measurement of report clarity, slightly improved and discrepancy rates decreased during the last 6 months of fellowship. A nadir for report turnaround times, discrepancy errors, and words addended to reports was seen in December and January.CONCLUSIONS:Progress through fellowship correlates with a decline in report turnaround times and discrepancy rates for cross-sectional neuroimaging call studies and slight improvement in indirect quantitative measurement of report clarity. These metrics can be tracked throughout the academic year, and the midyear would be a logical time point for programs to assess objective progress of fellows and address any deficiencies.

A fellow''s progress in an academic year is primarily assessed using qualitative, thus subjective, criteria, including achievement of Accreditation Council for Graduate Medical Education–prescribed milestones and faculty evaluations. While the Accreditation Council for Graduate Medical Education provides requirements for total yearly cases read¹ and individual programs may have internal metrics for fellows'' progress, there are no concrete external objective measurements for documenting fellows'' progress within the academic year. Often, fellows are unsure whether their efficiency in generating reports, report turnaround times (RTATs) for on-call examinations, or quality of on-call reports is satisfactory.The total number of studies dictated by the fellow and the RTATs of on-call studies may be reviewed by the attendings and program director with the fellows, but more meaningful interpretation of these numbers is lacking because there are no comparison benchmarks or quantitative checkpoints within the fellowship year. Knowledge of these factors is critical in a fellowship program so that program directors and fellows are jointly aware of progress throughout the year and remediation or additional focused training can be implemented, as necessary. More data on neuroradiology fellowship training are especially needed because a survey in 2016 demonstrated that 25% of practicing neuroradiologists in the United States believe that fellows'' abilities have declined.² Prior studies have analyzed various other factors related to radiology residency training, including total cases read, turnaround time, and on-call accuracy,^3,4 but to our knowledge, no studies have analyzed the quantitative trends in fellowship training during an academic year.We hypothesized that within an academic year, the RTAT for on-call studies dictated by fellows will decrease (ie, improve). Meanwhile, the discrepancy rates will decrease, and clarity of reports will improve. We also hypothesized that participating in independent call will have residual short-term effects on increasing clinical productivity during a subsequent regular work week.     

Sonography and neurodiagnosis (neurosonography)

Sonography is a necessary part of neuroradiology. Its relative importance will increase as the sonographic images improve and the funds provided for diagnostic imaging decrease. We urge the incorporation of neurosonographic training into our neuroradiology fellowship programs and more widespread use of sonography in neurodiagnosis.     

Trends in research productivity of residents applying for orthopedic sports medicine fellowship

Objectives: Though there are no research requirements to match into an orthopaedic sports medicine fellowship, many applicants are productive in research endeavors during residency. We hypothesize that the number of publications by Orthopaedic sports medicine applicants are increasing.

Methods: A list of current and recent sports medicine fellows was compiled from publicly accessible information on sports medicine fellowship websites. Articles published while the fellow was a resident were identified via publicly available search engines. The following information was collected: year of fellowship and years of residency, fellowship program, geographic location of fellowship program, total number of publications (noting specifically first and last author publications), number of publications in high impact orthopaedic journals (AJSM, JBJS Am, JSES, or Arthroscopy).

Results: Overall, 189 fellowship-matched surgeons from 2010 – 2017 were identified. There were 746 publications (average of 3.95 per fellow), with 218 (29.2%) in high impact orthopaedic journals. Surgeons who completed their fellowship during the 2016–17 academic year, published on average 5.42 publications per fellow. Fellowship applicants in the Northeast region had the highest number of total publications (359 publications, 48.1% of all publications; 6.41 publications per fellow). Applicants were listed most often as middle authors (462 publications, 61.9%).

Conclusions: There has been an overall increase in the number of publications among sports medicine fellowship applicants in the last several academic years. Fellowship programs in the northeast United States tended to match applicants with a higher number of publications.     

Advertise Right by Addressing the Concerns: An Evaluation of Women's/Breast Imaging Radiology Fellowship Website Content for Prospective Fellows

PurposeFellowship is an important part of postgraduate medical training as it facilitates advanced training in a subspecialty of interest. Internet is the most readily available and frequently used tool for acquiring information about the fellowship programs by residents worldwide. The aim of this study was to analyze the content of the websites of American and Canadian breast/women's imaging fellowship programs.MethodsThe content of active Canadian and American breast/women's imaging fellowship websites was collected and analyzed in August 2019 using 27 different criteria in the categories of application process, recruitment, education, research, clinical work, and incentives. The fellowship program without a webpage were excluded from the study.ResultsOut of 76 active breast/women's imaging Radiology fellowship programs in the US and Canada, 75 had dedicated fellowship websites available for analysis. One program was excluded due to lack of a dedicated website. On average, websites showcased 11 of the 27 criteria (40.0%). The category with the least prevalent information was incentives especially career placement after completion of the fellowship (1/75, 1.3%). Majority of the programs around 80.0% (60/75) had adequate information about the application process and requirements.The mean number of schools satisfying the different groups of criteria differed (P< 0.01); more schools satisfied the application criteria (60.5/75; 79.6% ± 20.3%) than the incentives (12.8/75; 16.8% ± 8.2%) and recruitment (24.5/75; 32.2% ± 29.7%) criteria.ConclusionMajority of the breast and women's imaging fellowship websites lack important information. Providing comprehensive online information about the program and application process may help the applicants to choose the best suited program for their academic needs and career progression.     

Evaluation of Pediatric Radiology Fellowship Website Content in USA and Canada

PurposeProspective radiology fellows often rely on the internet to obtain valuable information regarding the application process as well as the unique qualities and aspects of different fellowship programs. The aim of this study was to analyze the content of Accreditation Council for Graduate Medical Education (ACGME) Pediatric Radiology Fellowship websites within the USA and Canadian Accredited Pediatric Radiology Fellowship program websites.MethodsAll active ACGME Pediatric Radiology fellowship websites as of October 2018 were evaluated using 26 criteria in the following domains: application process, recruitment, program structure, education, research, clinical care, and incentives. Fellowships without websites were excluded from the study. Canadian programs were compiled from a list obtained as of October 2018 from the Canadian Association of Radiologists fellowship directory. Each fellowship program was evaluated using the same 26 criteria as the US programs.Results45 active ACGME Pediatric Radiology fellowship programs and 9 Canadian programs were identified. 43 of the US fellowships (96%), and 8 of the Canadian fellowships (89%) had dedicated fellowship websites available for analysis. For US data, websites on average contained 8 out of the 26 data points (31%). Whereas, in Canada, websites on average contained 11 out of the 26 data points (41%).ConclusionMost fellowship websites demonstrate several information deficiencies. This presents an actionable opportunity for individual programs to better inform trainees, promote Pediatric Radiology, and attract the highest quality applicants.     

Emergency radiology fellowship training in the USA: a web-based survey of academic programs

Interest in emergency radiology as a distinct subspecialty within radiology continues to rise in the USA and globally. While acute care imaging has been performed since the earliest days of the specialty, fellowship training in emergency radiology is a relatively new phenomenon. The purpose of this study was to examine the current status of emergency radiology training in the USA, using data derived from the official websites of US residency training programs. The most current list of radiology residency programs participating in the 2017 match was obtained from the official Electronic Residency Application Service (ERAS) website. The total number of emergency radiology fellowships was recorded after visiting available websites of each academic radiology program. The total number of subspecialty fellowships offered by each academic radiology program was also recorded. There were 12 confirmed emergency radiology fellowships offered in the USA for a combined total of 22 fellowship positions. Eleven programs were 1 year in duration, with one program offering a one- or two-year option. One hundred eight of the 174 (approximately 62 %) surveyed academic radiology programs offered at least one subspecialty fellowship. Emergency radiology fellowships are on the rise, paralleling the growth of emergency radiology as a distinct subspecialty within radiology.     

Women Radiologists in the United States: results from the American College of Radiology's 2003 Survey

PURPOSE: To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work. MATERIALS AND METHODS: The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists. RESULTS: Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men. CONCLUSION: Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.     

Invasive Procedural Versus Diagnostic Imaging and Clinical Services Rendered by Radiology Trainees Over Two Decades

PurposeTo characterize evolving radiology trainee exposure to invasive procedures.MethodsUsing Physician/Supplier Procedure Summary Master Files from 1997 to 2016, we identified Medicare services performed by radiology trainees in approved programs by extracting information on services billed by diagnostic and interventional radiologists reported with “GC” modifiers. Services were categorized as (1) invasive procedures, (2) noninvasive diagnostic imaging services, or (3) clinical evaluation and management (E&M) services. Relative category trainee work effort was estimated using service-level work relative value units.ResultsNationally from 1997 to 2016, invasive procedures declined from 34.2% to 14.3% of relative work effort for all Medicare-billed radiology trainee services. Radiology trainees’ noninvasive diagnostic imaging services increased from 65.1% to 85.4%. Clinical E&M services remained uniformly low (0.7%-0.3%). Diagnostic radiology (DR) and interventional radiology (IR) faculty supervised 81.0% and 19.0%, respectively, of all trainee invasive procedures in 1997, versus 68.3% and 31.7%, respectively, in 2016. Despite declining relative procedural work, trainees were exposed to a wide range of both basic and complex invasive procedures in both 1997 and 2016. Over this period, trainee noninvasive diagnostic imaging services shifted away from radiography to CT and MRI.ConclusionRadiology trainees’ relative invasive procedural work effort has declined over time as their work increasingly focuses on CT and MRI. As DR and IR-DR residency curricula begin to diverge, it is critical that both DR and IR residents receive robust training in basic image-guided procedures to ensure broad patient access to these services.     

American Society of Neuroradiology research survey 2001

RATIONALE AND OBJECTIVES: Research is a critical component of the mission of academic radiology, and success in research is necessary for the future of neuroradiology. Thus, the authors set out to establish a baseline of research activities of American Society of Neuroradiology (ASNR) members. MATERIALS AND METHODS: The authors surveyed 100 fellowship program directors. The survey was Web based, with recruitment from the ASNR Fellowship Database survey site and with e-mail and fax solicitations to the Web site. Questions focused on neuroradiologist and neuroradiology fellow involvement in research. RESULTS: Forty-eight of the 100 program directors (48%) responded. Several key findings emerged: (a) About one-third of fellowship programs require all fellows to do some research, with most fellows receiving less than 1 day per week of academic time; (b) just over half of the programs expect fellows to publish a paper; (c) about two-thirds of academic neuroradiologists get at least 1 academic day per week; (d) most academic neuroradiologists perform research, but most of this research is unfunded; and (e) about nine of 10 academic sections have at least one neuroradiologist with some extramural funding. CONCLUSION: The relative lack of extramural funding among academic neuroradiologists is a reality that is probably multifactorial; however, there may be a direct relationship between amount of academic time free from clinical duties and successful competition for funding. The time (and, thus, financial) support of research-oriented fellows and faculty should be increased.     

National radiology fellowship match program: success or failure?

In early 2003, with strong support from radiology leaders, the first national fellowship match was conducted in radiology. Most programs (358 programs in 9 categories) in the country participated, and 411 positions were filled out of 769 available in the match. Residents who selected to stay at their home departments were chosen before the match. A survey was conducted after the match to assess the satisfaction of chairpersons, program directors, and residents. Overall, the match was rated a success. However, a number of the pediatric fellowship programs remained outside of the match, possibly threatening its future. The initial radiology fellowship match that involved all fellowship specialties was deemed by residents and program leaders to be an overall success. Future matches will attempt to deal with such issues as incomplete participation. A significant problem is the continuing excess of offered fellowship positions over the number of applicants.