Examining Gender Disparity in Academic Abdominal Radiology in North America

BackgroundGender disparity exists in nearly every medical specialty, particularly in leadership roles and academia. Radiology is not exempt from this phenomenon, with women making up less than a third of radiology residents in the United States (US). This can have long-lasting effects on the career progression of female radiologists. Our search did not reveal any study on gender composition in academic abdominal radiology.PurposeTo evaluate the academic productivity and career advancement of female academic abdominal radiology faculty in the United States and Canada.Materials and methodsParameters of academic achievement were measured, including the number of citations and publications, years of research, as well as H-index. Information regarding academic and leadership ranking among academic abdominal radiologists in the United States and Canada was also analyzed.ResultsIn academic abdominal radiology, there were fewer females than males (34.9% vs 65.1%; p-value 0.256). Among the female radiologists, the greatest proportion held the rank of assistant professor (40%). Female representation decreased with increasing rank. Females had a lower H-index than males (P-value = 0.0066) and significantly fewer years of research than males (P-value = 0.0243).ConclusionMale predominance in academic abdominal radiology is similar to many other medical specialties, and encompasses senior faculty rank, leadership roles and research productivity.     

Gender Disparity in Radiology Society Committees and Leadership in North America and Comparison With Other Continents

PurposeTo evaluate gender distribution in radiology professional society leadership positions. Our study intends to assess and compare the gender distribution among leadership roles and professional society committee memberships of the radiology societies and seek an understanding of potential associations between gender, academic research metrics, institutional academic rank, and leadership roles.MethodsWe identified radiology professional society committee members to assess relative gender composition in 28 radiology societies in North America, Europe, and Australia/New Zealand. The research metrics were obtained from the SCOPUS database and demographics and institutional affiliation through institutional websites' internet searches. Gender distribution by academic ranks and other discontinuous variables were analyzed using the Chi-Square test. Wallis tests.ResultsOf the 3011 members of society committees, 67.9% were male, and 32.1% female. Among all the society members, the data showed that the proportion of committee members holding leadership positions was comparable between males (25.7%) and females (22.5%). However, when we did a subgroup analysis and disaggregated the data by leadership positions, we noted that among those who held the leadership positions, the proportion of males was more significant (n = 526, 70.7%) compared to females (n = 218, 29.3%). Overall, males had higher median publications, citations, H-indices, and active years of research (P< 0.0001). At all university academic ranks, men outnumbered females (P = 0.0015, Chi-square 15.38), with the most considerable disparity at the rank of professor (71.9% male, 28.1% female, P = 0.0003).ConclusionThere was male predominance amongst committee members in radiology societies. Our study found no significant differences between those in leadership positions, suggesting that once a member of a committee, females are equally likely as males to attain leadership positions. Analysis of committee members' academic rank and committee leaders demonstrated underrepresentation of females at higher academic ranks, and males overall had higher research metrics than females.     

Gender Disparity in Chest Radiology in North America

PurposeIn the current cultural climate, gender disparity is a topical and contentious issue. In academic medicine, there is an underrepresentation of female faculty in leadership positions with lower research output and fewer grant awards. We study the gender differences in faculty rank, leadership positions, and research output among chest radiologists in North America.Materials and MethodsA list of clinical faculty at radiology programs in North America was obtained using the FREIDA database and program websites. Demographic information and data pertaining to academic rank, peer-reviewed publications, and research productivity of each chest radiologist was obtained from Doximity and SCOPUS databases.ResultsFour hundred ten (281 male:129 female) academic chest radiologists were included. Females were underrepresented at senior faculty level accounting for 18.8% (n = 21) of full, 29.2% (n = 21) of associate and 40.7% (n = 61) of assistant professors. 23.1% (n = 14) of department chiefs were women. Women were more likely to occupy a faculty position in chest radiology in Canada than in US (P < 0.05). The median H-index, and numbers of publications and citations were lower for females than male faculty (P < 0.05). Male faculty had more years of experience – median of 19 years, 16.5 years for females (P < 0.05).ConclusionsGender disparity exists in chest radiology with similar male predominance in terms of senior faculty rank, leadership roles, and research productivity to other medical specialties. The observed deficiency of research and scholarly output among female chest radiologists and the paucity of aspirational female radiologists in senior academic/leadership positions are factors which perpetuate this gender disparity and contribute to persistence of the gender pay gap.     

Burnout,Professional Fulfillment,Intention to Leave,and Sleep-Related Impairment Among Faculty Radiologists in the United States: An Epidemiologic Study

ObjectiveTo examine the prevalence of burnout in faculty radiologists in the United States and to explore the relationship between burnout and professional fulfillment (PF), intention to leave (ITL), and sleep-related impairment by gender.MethodsThis cross-sectional study was conducted through a voluntary anonymous, electronic survey of radiologists at 11 academic medical institutions participating in the Physician Wellness Academic Consortium between January 2017 and September 2018. Faculty radiologists who completed the survey were included in the study. The survey contained the validated professional fulfillment index and National Institute of Health Patient Reported Outcomes Measurement Information System sleep-related impairment scale. Demographics of participants only included gender to protect anonymity. Sample t tests and χ² exact tests were used for analysis with significance level set at P < .05.ResultsIn all, 456 faculty radiologists (171 women) answered the survey. The overall prevalence of burnout was 37.4%, PF was 35.6%, ITL was 33.3%, and sleep-related impairment was 45.3%. Burnout was higher in female versus male respondents (44% versus 31%, P < .05), and PF and ITL were lower (30% versus 42%, P < .05, 26% versus 38%, P < .05, respectively). When faculty were stratified into burned out versus not burned out, PF was significantly lower in those with burnout (12% versus 52%, P < .05), and ITL and sleep-related impairment was higher (51% versus 24%, P < .05 and 75% versus 30%, P < .05, respectively).DiscussionHigher burnout was associated with reports of greater ITL and sleep-related impairment and lower PF. Female radiologists experience more burnout but less ITL than their male counterparts.     

Women in Radiology: Exploring the Gender Disparity

PurposeIn 2015, only 1.5% of female Canadian medical students pursued radiology as a specialty, versus 5.6% of men. The aim of this study was to determine what factors attract and deter Canadian medical students from pursuing a career in radiology, and why fewer women than men pursue radiology as a specialty.MethodsAn anonymous online survey was e-mailed to English-speaking Canadian medical schools, and 12 of 14 schools participated. Subgroup analyses for gender and radiology interest were performed using the Fisher exact test (P < .05).ResultsIn total, 917 students (514 women; 403 men) responded. Direct patient contact was valued by significantly more women who were not considering specialization in radiology (87%), compared with women who were (70%; P < .0001). Physics deterred more women (47%) than it did men (21%), despite similar educational backgrounds for the two gender groups in physical sciences (P < .0001). More women who were considering radiology as a specialty rated intellectual stimulation as being important to their career choice (93%), compared with women who were not (80%; P = .002). Fewer women who were not interested in radiology had done preclinical observerships in radiology (20%), compared with men who were not interested in radiology (28%; P = .04).ConclusionsA perceived lack of direct patient contact dissuades medical students from pursuing radiology as a career. Women have less preclinical radiology exposure than do men. Programs that increase preclinical exposure to radiology subspecialties that have greater patient contact should be initiated, and an effort to actively recruit women to such programs should be made.     

Early Adoption of a Certainty Scale to Improve Diagnostic Certainty Communication

ObjectiveAssess the early voluntary adoption of a certainty scale to improve communicating diagnostic certainty in radiology reports.MethodsThis institutional review board–approved study was part of a multifaceted initiative to improve radiology report quality at a tertiary academic hospital. A committee comprised of radiology subspecialty division representatives worked to develop recommendations for communicating varying degrees of diagnostic certainty in radiology reports in the form of a certainty scale, made publicly available online, which specified the terms recommended and the terms to be avoided in radiology reports. Twelve radiologists voluntarily piloted the scale; use was not mandatory. We assessed proportion of recommended terms among all diagnostic certainty terms in the Impression section (primary outcome) of all reports generated by the radiologists. Certainty terms were extracted via natural language processing over a 22-week postintervention period (31,399 reports) and compared with the same 22 calendar weeks 1 year pre-intervention (24,244 reports) using Fisher’s exact test and statistical process control charts.ResultsOverall, the proportion of recommended terms significantly increased from 8,498 of 10,650 (80.0%) pre-intervention to 9,646 of 11,239 (85.8%) postintervention (P < .0001 and by statistical process control). The proportion of recommended terms significantly increased for 8 of 12 radiologists (P < .0005 each), increased insignificantly for 3 radiologists (P > .05), and decreased without significance for 1 radiologist.ConclusionDesigning and implementing a certainty scale was associated with increased voluntary use of recommended certainty terms in a small radiologist cohort. Larger-scale interventions will be needed for adoption of the scale across a broad range of radiologists.     

Integration of a Community Radiology Division into a Subspecialty-Focused Academic Radiology Department

IntroductionAssimilate a general radiology division into a subspecialty-focused radiology department at an academic medical center.MethodsThis Institutional Review Board-approved quality improvement initiative was performed at an academic medical centers’ subspecialty-focused academic radiology department, aiming to assimilate a general radiology division providing interpretive services for a distributed set of community ambulatory practices. An Oversight Committee charged by the department chair created a charter with unambiguous goal, timelines, clear decision-making, and conflict resolution processes. The Committee assessed the resources and clinical capabilities of the general radiologists, and the anticipated shift in exam volume from the community into subspecialty divisions. Primary outcome, percentage of targeted organ systems-specific interpretations by general radiologists based on assigned subspecialty division, and secondary outcome of report turnaround time (TAT) for all ambulatory exams, were compared before and after sub-specialization.ResultsAmong 10 general radiologists, 4.5 were assigned to subspecialty divisions; 5.5 continued to cover an independent general radiology practice in a for-profit delivery network. In the 5 months’ post-transition, a total 86.6% (11,668/13,477) of reports by the integrated general radiologists were within designated subspecialty divisions vs 23.9% (2,586/10,829) pre-transition (P < 0.01). There was no change in ambulatory radiology report TAT for non-urgent care center (UCC) or UCC exams pre- vs post-integration.DiscussionA quality improvement initiative with unambiguous decision-making and conflict resolution processes incorporated a general radiology practice (radiologists and exams) into a subspecialty-focused academic radiology practice without negatively impacting TAT metrics. Future studies would be needed to assess impact on quality of interpretations.     

The Challenge With Clinical Radiology Electives: Student and Faculty Perspectives Identify Areas for Improvement

PurposeTo determine medical students' and radiologists’ attitude toward radiology electives at a distributed medical school and identify specific areas for improvement.MethodsDuring a single academic year, both students and faculty preceptors were surveyed anonymously following a senior radiology elective. The survey was based on an established theoretical framework for studying the educational environment which takes into account domains: (1) goal orientation, (2) organization/regulation, and (3) relationships. Mann-Whitney tests were performed to determine if there was any difference between the overall satisfaction of students and preceptors, responses from the different elective sites and students’ ratings of the domains. Statistical significance was set at P < .05. Thematic analysis was performed on the narrative comments to identify specific challenges.ResultsThe response rate was 82.0% for students (95/116) and 19.5% (31/159) for radiologists. There was no difference in responses based on elective site. Overall, the elective was viewed positively by both groups however students rated their experience as significantly better than their preceptors (P = .0012). Students viewed the relationships domain more positively than both the other two (goal orientation, P = .0001; organization/regulation, P = .0038). Thematic analysis identified that the student challenges were lack of autonomy, structured teaching, and preceptor continuity and the preceptor challenges were ambiguous learning objectives/expectations and insufficient resources.ConclusionsThe radiology elective challenges identified in this study provide educators with specific areas to target when updating radiology electives. A better elective experience may improve students' radiology knowledge and attitude towards the specialty as well as radiologists’ interest in teaching.     

Preventive Care: How Mammography Utilization Changes as Women Age

ObjectiveTo evaluate the impact of comorbid conditions and age on mammography use.MethodsWe used data from the 2011 to 2015 Medical Expenditure Panel Survey, which contained records for 40,752 women over the age of 40. Use was defined as a mammogram within the previous 1 or 2 years, analyzed separately. A logit model was employed to evaluate associations between use and comorbidities and age. Statistical significance was defined by a P < .05 by two-sided test.ResultsOf the 36,575 women in our study sample, 45.9%, 43.6%, 3.9%, and 5.7% reported a history of hypertension (HTN), hyperlipidemia (HLD), prior heart attack (MI), and prior stroke, respectively. Among women without a comorbid condition, there was 47.3% annual mammography use. HTN and HLD were associated with increased use (2.5 and 6.8 percentage points [pp], P< .01). In comparison, prior MI was associated with decreased annual use (−8.2 pp, P < .01). Prior stroke was not significantly associated with annual mammography (−1.5 pp, P = .42). Results were similar for biennial use. The age trend in use showed that the age with maximum screening use was approximately 60 years.DiscussionMammography use was higher in patients with HTN and HLD and lower in patients with prior MI and stroke, which may reflect differences in comorbidity-related general health care use. Use increased until it peaked around age 60. An understanding of how mammography use naturally evolves as people age may help better target specific populations and improve overall use of preventive care.     

Current State of Private Practice and Academic Interventional Radiology: Differences in Practice Structure,Case Mix,and Productivity

PurposeTo investigate whether private practice interventional radiology (IR) groups self-report higher overall productivity given differing case mix and more diagnostic radiology interpretation.Materials and MethodsA 60-question survey was distributed to 3,159 self-identified US IR physicians via the Society of Interventional Radiologists member search engine, with 357 responses (11.3% response rate). Of these responses, there were 258 unique practices from 34 US states.ResultsOut of 84 IR group responses, private practice IR (PPIR) physicians reported a minimal trend for higher annual work relative value units (wRVUs) per clinical full-time equivalent compared with academic IR physicians (8,000 versus 7,140, P = .202), but this did not reach statistical significance. PPIR groups reported fewer median weekly hours (50 versus 52), more frequent call (every 6 versus every 5 days), and significantly higher median tenured compensation ($573,000 versus $451,000, P = .000). Out of 179 responses, academic practices reported significantly higher case percentages of interventional oncology and complex hepatobiliary intervention (P <.001), and private practices reported significantly higher percentages of musculoskeletal intervention (P < .001) with a nonsignificant trend for stroke or neurologic intervention (P = .010). Private practices reported more wRVUs from the interpretation of diagnostic imaging, at 26% of total wRVU production compared with 7% of total wRVU production for academic practices (P < .001; n = 131).ConclusionsSelf-reported data from private and academic IR groups suggest minimally higher wRVUs per clinical full-time equivalent among PPIRs with lower weekly work hours, more frequent call, differing case mix, and significantly higher tenured compensation among PPIR groups.     

First-Year Radiology Residents Teaching Anatomy to First-Year Medical Students: A Symbiotic Relationship

ObjectivesOur institution has developed an educational program in which first-year radiology residents teach first-year medical students during gross anatomy laboratory sessions. The purpose of this study is to assess the impact of this program on medical student knowledge and perceptions of radiology, and on resident attitudes toward teaching.Materials and MethodsFirst-year resident pairs taught small groups of medical students during weekly 15-minute interactive sessions, and were evaluated on teaching skills by senior residents. A survey about attitudes toward radiology and a knowledge quiz were sent to the medical students, and a survey about attitudes toward teaching was sent to the first-year radiology residents, both pre-course and post-course.ResultsStudents’ radiology knowledge significantly increased between the pre-course and post-course survey across all categories tested (P < 0.001). Additionally, there were significant improvements in terms of students’ confidence in radiologic anatomy skills, perceived importance of radiology for medical training, familiarity with the field of radiology, and perception that radiologists are friendly (P < 0.001). Radiology residents felt more confident in their teaching proficiency (P < 0.001) by the conclusion of the course.ConclusionsResident-led small-group teaching sessions during anatomy laboratory are mutually beneficial for medical students and radiology residents. The program also allows radiology residents to be exposed early on in residency to teaching and academic medicine.     

Institutional Interventional Radiology Symposium Increases Medical Student Interest and Identifies Target Recruitment Candidates

ObjectivesTo assess and raise medical student interest in interventional radiology (IR); and to evaluate student response across gender, level of training, and surgical vs nonsurgical specialty interest.Materials and MethodsAll Ohio medical students were invited to an IR Symposium held by a large academic medical center in central Ohio. The program encompassed didactic lectures, hands-on simulation models, and a networking luncheon with faculty, trainees, and industry partners. All attendees completed an anonymous, 5-point Likert scaled survey preattending and postattending the event to assess their awareness of IR as a specialty, understanding of the current training pathways, and level of interest.ResultsA total of 46 participants (M:F 60%:40%, MS1—53%, MS2—36%, and MS3—11%) attended the symposium. The cohort demonstrated increased interest in pursuing a career in IR following the symposium (4.12 vs 3.70, P < 0.001). Students with an interest in a nonsurgical specialty showed an increased interest in IR (4.20 vs 3.68, P < 0.001), whereas surgically oriented students did not demonstrate a significant increase (4.00 vs 3.71, P = 0.375). No statistically significant differences were noted across gender or level of training. The symposium experience significantly increased understanding of the IR training pathways (4.51 vs 2.94, P < 0.001). Students rated lectures (57%) and endovascular simulators (41%) as the most useful experiences.ConclusionsThis study demonstrated the role of symposia in improving medical student awareness of IR and training pathways. Findings were validated across gender and training level, and identified the subset of students with nonsurgical interests as most responsive to such intervention and potential recruitment.     

CT and MRI Protocol Variation and Optimization at an Academic Medical Center

PurposeTo reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way.Materials and MethodsThis study was performed at a large academic radiology practice performing ∼800,000 radiology examinations annually. To diminish variability across the enterprise (2 general radiology divisions; 10 subspecialty imaging divisions), a Harmonization Oversight Committee was created and tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged. A process for decision making and conflict resolution was established, supported by the department chair. Primary outcome measure was standardization of CT and MRI protocols across all sites. Secondary outcome was percent reduction of CT and MRI protocols postharmonization.ResultsOver the 5-month harmonization process, most conflicts arose for abdominal imaging protocols because they are performed in four distinct subspecialty divisions, but all were addressed effectively through the conflict resolution process. Overall, there was a 31% reduction in the total number of CT and MRI protocols (before harmonization 481, after harmonization 331). There was significant variation in reduction of protocols per workgroup (multiple P values; range <.0001 to .9) with largest reduction in workgroups that overlapped multiple divisions.ConclusionA structured, organ system– and consensus-based quality improvement process with unambiguous decision-making and conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices so that patients with similar clinical presentations are imaged with the same imaging protocol.     

Influences of Radiology Trainees on Screening Mammography Interpretation

PurposeParticipation of radiology trainees in screening mammographic interpretation is a critical component of radiology residency and fellowship training. The aim of this study was to investigate and quantify the effects of trainee involvement on screening mammographic interpretation and diagnostic outcomes.MethodsScreening mammograms interpreted at an academic medical center by six dedicated breast imagers over a three-year period were identified, with cases interpreted by an attending radiologist alone or in conjunction with a trainee. Trainees included radiology residents, breast imaging fellows, and fellows from other radiology subspecialties during breast imaging rotations. Trainee participation, patient variables, results of diagnostic evaluations, and pathology were recorded.ResultsA total of 47,914 mammograms from 34,867 patients were included, with an overall recall rate for attending radiologists reading alone of 14.7% compared with 18.0% when involving a trainee (P < .0001). Overall cancer detection rate for attending radiologists reading alone was 5.7 per 1,000 compared with 5.2 per 1,000 when reading with a trainee (P = .517). When reading with a trainee, dense breasts represented a greater portion of recalls (P = .0001), and more frequently, greater than one abnormality was described in the breast (P = .013). Detection of ductal carcinoma in situ versus invasive carcinoma or invasive cancer type was not significantly different. The mean size of cancers in patients recalled by attending radiologists alone was smaller, and nodal involvement was less frequent, though not statistically significantly.ConclusionsThese results demonstrate a significant overall increase in recall rate when interpreting screening mammograms with radiology trainees, with no change in cancer detection rate. Radiology faculty members should be aware of this potentiality and mitigate tendencies toward greater false positives.     

Trainee and Faculty Perceptions of Remote PACS Workstations and Next Steps in a Large US Academic Medical Institution

ObjectiveRemote workstations were rapidly deployed in our academic radiology practice in late March 2020 in response to the COVID-19 pandemic. Although well-received by faculty, there were concerns for the impact on resident education.Materials and MethodsSurveys of the radiology trainees and faculty were conducted online seven- and thirteen-months following workstation deployment as a part of a quality improvement project to assess the impact on radiology education and faculty wellness, as well as assess the desired trajectory of remote work in an academic setting.ResultsThe majority of trainees (52%) reported the implementation had negatively impacted resident education, greatest among lower level residents (p < .001). This perception did not change despite interventions and perceived improvement in teleconferencing.Greater than 75% of radiologists with remote workstations reported improved wellness and lower stress levels compared to the onsite radiologists. The majority of all respondents voted to continue or expand remote work following the COVID-19 pandemic in both surveys.ConclusionsOnsite teaching is important for the education of residents, particularly for lower-level residents. However, the adoption of a hybrid model in an academic setting may prove beneficial for faculty wellness and recruitment of the next generation.     

Impact of Simulation-Based Training on Radiology Trainee Education in Ultrasound-Guided Breast Biopsies

PurposeThe aim of this study is to determine the impact of a simulation-based ultrasound-guided (USG) breast biopsy training session on radiology trainee procedural knowledge, comfort levels, and overall procedural confidence and anxiety.MethodsTwenty-one diagnostic radiology residents from a single academic institution were recruited to participate in an USG breast biopsy training session. The residents filled out a questionnaire before and after the training session. Ten multiple-choice questions tested general knowledge in diagnostic breast ultrasound and USG breast biopsy concepts. Subjective comfort levels with ultrasound machine and biopsy device functionality, patient positioning, proper biopsy technique, image documentation, needle safety and overall procedural confidence and anxiety levels were reported on a 5-point Likert scale before and after training.ResultsParticipants demonstrated significant improvement in number of correctly answered general knowledge questions after training (P < .0001). Significant improvement was seen in resident comfort level in ultrasound machine functionality, patient positioning, biopsy device functionality, biopsy technique, image documentation, as well as overall confidence level (all P < .05). Participants indicated a slight but not significant reduction in anxiety levels (P = .27).ConclusionsA simulation-based USG breast biopsy training session may improve radiology trainee procedural knowledge, comfort levels, and overall procedural confidence.     

Comparing Preliminary and Final Neuroradiology Reports: What Factors Determine the Differences?

BACKGROUND AND PURPOSE:Trainees'' interpretations of neuroradiologic studies are finalized by faculty neuroradiologists. We aimed to identify the factors that determine the degree to which the preliminary reports are modified.MATERIALS AND METHODS:The character length of the preliminary and final reports and the percentage character change between the 2 reports were determined for neuroradiology reports composed during November 2012 to October 2013. Examination time, critical finding flag, missed critical finding flag, trainee level, faculty experience, imaging technique, and native-versus-non-native speaker status of the reader were collected. Multivariable linear regression models were used to evaluate the association between mean percentage character change and the various factors.RESULTS:Of 34,661 reports, 2322 (6.7%) were read by radiology residents year 1; 4429 (12.8%), by radiology residents year 2; 3663 (10.6%), by radiology residents year 3; 2249 (6.5%), by radiology residents year 4; and 21,998 (63.5%), by fellows. The overall mean percentage character change was 14.8% (range, 0%–701.8%; median, 6.6%). Mean percentage character change increased for a missed critical finding (+41.6%, P < .0001), critical finding flag (+1.8%, P < .001), MR imaging studies (+3.6%, P < .001), and non-native trainees (+4.2%, P = .018). Compared with radiology residents year 1, radiology residents year 2 (−5.4%, P = .002), radiology residents year 3 (−5.9%, P = .002), radiology residents year 4 (−8.2%, P < .001), and fellows (−8.7%; P < .001) had a decreased mean percentage character change. Senior faculty had a lower mean percentage character change (−6.88%, P < .001). Examination time and non-native faculty did not affect mean percentage character change.CONCLUSIONS:A missed critical finding, critical finding flag, MR imaging technique, trainee level, faculty experience level, and non-native-trainee status are associated with a higher degree of modification of a preliminary report. Understanding the factors that influence the extent of report revisions could improve the quality of report generation and trainee education.

Understanding the prevalence, causes, and types of discrepancies and errors in examination interpretation is a critical step in improving the quality of radiology reports. In an academic setting, discrepancies and errors can result from nonuniform training levels of residents and fellows. However, even the “experts” err, and a prior study found a 2.0% clinically significant discrepancy rate among academic neuroradiologists.¹ A number of factors can affect the accuracy of radiology reports. One variable of interest at teaching hospitals is the effect of the involvement of trainees on discrepancies in radiology reports. Researchers have found that compared with studies read by faculty alone, the rate of clinically significant detection or interpretation error was 26% higher when studies were initially reviewed by residents, and it was 8% lower when the studies were initially interpreted by fellows.² These findings suggest that perhaps faculty placed too much trust in resident interpretations, which led to a higher rate of discrepancies, while on the other hand, having a second experienced neuroradiology fellow look at a case can help in reducing the error rate.²In our academic setting, preliminary reports initially created by trainees are subsequently reviewed and finalized by faculty or staff. The changes made to preliminary reports are a valuable teaching tool for trainees because clear and accurate report writing is a critical skill for a radiologist.³ Recently, computer-based tools have been created to help trainees compare the changes between preliminary and final reports to improve their clinical skills and to facilitate their learning. Sharpe et al⁴ described the implementation of a Radiology Report Comparator, which allows trainees to view a merged preliminary/final report with all the insertions and deletions highlighted in “tracking” mode. Surrey et al⁵ proposed using the Levenshtein percentage or percentage character change (PCC) between preliminary and final reports as a quantitative method of indirectly assessing the quality of preliminary reports and trainee performance. The Levenshtein percentage, a metric used in computer science, compares 2 texts by calculating the total number of single-character changes between the 2 documents, divided by the total character count in the final text.⁵In this study, we analyzed preliminary neuroradiology reports dictated by trainees and the subsequent finalized reports revised by our faculty. We set out to identify the factors that determine the degree to which the preliminary reports are modified by faculty for residents and fellows, for daytime and nighttime shifts, and for CT and MR imaging examinations. We hypothesized that study complexity, lack of experience (for both trainee and faculty), and perhaps limited language skills (native-versus-non-native speaker) would result in a greater number of corrections.     

Assessing the Gap in Female Authorship in Radiology: Trends Over the Past Two Decades

PurposeThe aim of this study was to retrospectively identify trends in the representation of female authorship in prominent general radiology journals over the past 2 decades.MethodsA comprehensive search was conducted for all articles published in 1993, 2003, and 2013 in Radiology, the American Journal of Roentgenology (AJR), European Radiology, and Investigative Radiology. The genders of the first and last authors were collected. Chi-square tests were used for statistical analysis, and P values < .05 were considered to indicate statistical significance.ResultsA total of 3,786 articles were reviewed. Overall, women constituted 20.0% authorship, 24.7% of first authors, and 15.2% of senior authors. The average overall female first and senior authorship grew from 19.7% to 32.1% and from 13.6% to 19.1%, respectively from 1993 to 2013. Female first authorship grew over the past 2 decades in the journals reviewed, with significant growth in AJR and Radiology (P < .0001). Female first authorship in the individual journals grew from 16.4%-29.1% in 1993, to 29.1%-34.8% in 2013. Female senior authorship also demonstrated growth in the past 2 decades, growing from 4.3%-17.5% in 1993 to 15.5%-23.2% in 2013. There was significant growth in senior female authorship in Radiology (from 12.1% to 19.2%, P = .004) and European Radiology (from 4.3% to 15.5%, P = .0433). Female senior authorship remained significantly lower than first authorship over the past 2 decades (P = .002, P < .001, and P < .0001).ConclusionsAlthough women’s growth in first authorship in radiology literature is proportional to their growth in the specialty, they continue to remain a minority, especially in senior authorship, and demonstrate similar participation to other medical specialties.     

Impact of Early Radiology Research Experiences on Medical Student Perceptions of Radiology and Research

Rationale and objectivesTo promote opportunities for medical students to gain early exposure to radiology and research, our institution has initiated programs which fund summer radiology research projects for rising second-year medical students. This study assesses the impact of these faculty-mentored summer research experiences on medical student perceptions of radiology and research, in terms of both knowledge and interest.Materials and methodsA voluntary, anonymous survey was administered to students both before and after the summer research period. Both the pre-program survey and post-program survey included 7-point Likert-scale questions (1 = strongly disagree; 7 = strongly agree) to evaluate students’ perceptions about research and students’ perceptions about radiology as a specialty. Faculty mentors were sent an analogous post-program survey that included an evaluation of their student's research skills.ResultsThe surveys were completed by 9 of 11 students and 10 of 11 mentors. Students’ perceived knowledge of radiology as a specialty improved (P = 0.02) between the pre-program survey and post-program survey. Similarly, there was an increase in students’ perceived knowledge of research skills (P = 0.02) between the pre-program survey and post-program survey, with student ratings of research skills consistent with those of mentors. High student interest in both radiology and research was maintained over the course of the program.ConclusionOur pilot study suggests that summer research experiences can improve knowledge of radiology and research among medical students. Continued evaluation of this annual program will allow us to enhance the benefit to medical students and thereby bolster interest in academic radiology.     

An Electronic Health Record Order Entry-Enabled Educational Intervention Is Not Effective in Reducing STAT Inpatient Radiology Orders

ObjectiveAssess whether introducing order priorities with defined performance expectations in the electronic health record (EHR) reduces immediate inpatient radiology orders.Materials and MethodsThis Institutional Review Board–approved, retrospective study was performed at a 776-bed academic hospital conducting 164,000+ inpatient radiology examinations annually. Study period was January 2, 2017, to July 23, 2017; 14 weeks pre- and postimplementation of an education-only intervention including replacing urgent and as soon as possible priorities with imaging within next 6, 12, or 24 hours; imaging in the morning; and required for discharge priorities. STAT routine, timed, today order priorities remained unchanged. Institution-wide training immediately pre- and postimplementation was provided through two waves of e-mail and electronic tip sheets. Primary outcome measure was total STAT studies ordered of total radiology studies ordered per week (STAT rate). Secondary outcomes were non-STAT, non-routine (non-SR) order rate, and routine order rate. Paired t test and statistical process control (SPC) analysis were performed.ResultsSTAT rate pre- (22.5%, 7,150 STAT of 31,765 total; weeks 1-14) and postintervention (23.4%, 7,481 STAT of 32,034 total; weeks 16-29) remained unchanged (P = .37). SPC demonstrated no special cause variation. Postintervention non-SR rate increased 3-fold (2.7%, 859 non-SR of 31,765 total pre-intervention versus 8.2%, 2,615 non-SR of 32,034 total postintervention; 8.2%/2.7% = 3.0; P < .0001). There was an 8.8% relative reduction in routine rate postintervention (73.9%, 23,471 routine of 31,765 total pre-intervention; 67.4%, 21,579 routine of 32,034 total postintervention; (73.9% ? 67.4%)/73.9% × 100 = 8.8%; P < .0001).ConclusionImplementing ordering priorities with defined performance expectations in the EHR reduced routine but did not reduce STAT inpatient radiology orders. More stringent interventions may be needed to reduce unnecessary STAT inpatient radiology ordering to improve use of limited imaging resources.