Report of the 1997 SCAROP survey on resident training. Society of Chairmen of Academic Radiation Oncology Programs

RATIONALE AND OBJECTIVES: Members of the Society of Chairmen of Academic Radiation Oncology Programs (SCAROP) were surveyed in November 1997 to evaluate the current status of radiation oncology training in the United States and to help determine how it should be carried out in the coming decade. MATERIALS AND METHODS: A detailed questionnaire was sent to all members of SCAROP; 68 of 82 questionnaires were returned, for a response rate of 83%. RESULTS: The responses to the survey show a serious shortage of radiation oncologists in university settings, despite an apparent surplus in private practice. Although recent changes in health care have added additional clinical responsibilities for radiation oncologists in university practices, approximately 75% of the chairpersons answering the survey continue to give their faculty protected time for research. Even with additional research and teaching responsibilities, the average radiation oncologist in university practice saw 206 patients per year in 1997, a number similar to that reported by the Patterns of Care Study for radiation oncologists overall. Approximately two-thirds of respondents believe that academic chairs should strive to have all clinical faculty members participating in research. Nevertheless, most think that basic research is better performed by dedicated researchers with PhD degrees rather than radiologists with MD degrees. Most respondents believe that the training programs adequately prepare radiation oncologists for a career in academic medicine but do not provide good training in research. Eighty-four percent agreed that resident performance on the American Board of Radiology examination should be considered in the accreditation of residency programs in radiation oncology but should not be the major criterion. CONCLUSION: There is a shortage of academic radiation oncologists in the United States despite the large number of radiation oncologists completing training. This probably is due to a variety of factors, including a relatively small pool of candidates for academic positions, increasing demands for performance from academic physicians (to see more patients, perform research, publish, write grants, and teach), and competition from the private sector for recruitment of these individuals.     

Results of and comments on the 1998 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 allows for comparison between programs regarding training and follows trends on current issues. MATERIALS AND METHODS: Questionnaires were mailed to all accredited programs in the United States (188 programs). The questionnaire consisted of questions regarding general demographic information and specific topics regarding residency training. The 1998 survey focused on turf issues, teleradiology use, residency selection, and prior training. RESULTS: Completed surveys from 61 programs (32.4%) were returned. Important findings included (a) the ongoing turf battles regarding vascular and obstetric-gynecologic ultrasound, both in general hospital and emergency department patients, (b) the use of teleradiology by most residents, and (c) the low percentage of women in radiology residency programs. CONCLUSION: The information obtained during yearly surveys is useful for program evaluation and future planning. Current survey results indicate an increasing use of teleradiology in residency over the past 4 years. The turf battles in ultrasonography (both vascular and obstetric) have remained unchanged over the same time frame.     

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

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

Lessons Learned From the COVID-19 Response in a Major New York City Hot Zone

The COVID-19 pandemic had significant impact on radiology departments across the United States. Radiology departments have adjusted to the effects of the pandemic. This article presents the changes made by the Radiology department at the Montefiore Medical Center (MMC) of the Albert Einstein College of Medicine located in the Bronx, New York City which is one of the major hot spots of the COVID-19 pandemic.     

Global Radiology Training Prevalence Among Radiology Residency Programs

ObjectiveGlobal Radiology aims to enhance access to medical imaging services and education, worldwide. To date, few reports have evaluated Global Radiology Training (GRT) in radiology residency programs. Here, we examined how radiology residency programs perceive and incorporate GRT into their curriculum, and how this information is promoted online.MethodsTwo methods were used to examine the current state of GRT. First, radiology residency program directors (identified via the Association of Program Directors in Radiology) were surveyed on topics including: Electives, institutional partnerships, resident and faculty involvement, inquiry by prospective residents, and barriers to implementation. Second, radiology residency program websites (n = 193) were examined for existing GRT on the programs’ publicly available webpages.ResultsThere were 62 survey responses (response rate of 19%). Thirty-eight percent (24/62) of residency programs offered a Global Radiology elective to their residents within the past academic year and 27% (17/62) of programs have active affiliations with medical institutions outside of the United States. Eighty-four percent of program directors (52/62) received questions from residency applicants regarding opportunities to participate in Global Radiology. Furthermore, only 13% (26/193) of all radiology residency programs listed at least one GRT elective on their webpage.DiscussionGRT in radiology residency is more widely available than previously reported and has been underrepresented on residency program websites. In the present survey, the majority of radiology residency program directors reported that radiology is an important component of Global Health, one-third of whom have already incorporated the subject into their curriculum. However, most common barriers to GRT include, perceived lack of time in the curriculum and lack of faculty interest. The high prevalence of inquiry from residency program applicants about GRT suggests that it may be a notable factor for applicants during the ranking process. Programs build up GRT may choose to share related information seeking to may choose to emphasize work in Global Radiology on their program webpages.     

Pregnancy and maternity leave: AAWR survey results

In 1987 to obtain information regarding pregnancy and maternity leave policies in academic and private radiology departments, the American Association of Women Radiologists (AAWR) surveyed academic and private diagnostic radiology departments and academic radiation oncology departments in the United States and Canada. One hundred thirty-one diagnostic radiology departments and 30 radiation therapy departments responded to the questionnaire. Despite the increasing number of women entering the field of radiology, many departments do not have formal policies. Of those that do, there was a wide range of responses regarding details of maternity leave and duties during pregnancy. The AAWR recommends that every department develop a written pregnancy and maternity leave policy, which should be available to all current and prospective employees.     

Use of productivity and financial indicators for monitoring performance in academic radiology departments: U.S. nationwide survey

PURPOSE: To determine how productivity- and finance-related indicators are used by radiology departments to evaluate departmental performance. MATERIALS AND METHODS: The study met the criteria to be exempt from institutional review board approval. All subjects were informed of the purpose of the study and that their questionnaire responses would be kept confidential. For the study, a survey was sent to 132 members of the Society of Chairmen of Academic Radiology Departments (SCARD) nationwide. The survey was designed to (a) assess organizational information about hospital and radiology departments, (b) determine the types and mean numbers of productivity and financial indicators used by radiology departments, (c) determine how these indicators are used to influence departmental productivity, and (d) assess the reference-standard goals with which each indicator value was compared. A total of 77 variables were studied. Summary statistics, Spearman rank correlation coefficient, and chi2 analyses were performed. RESULTS: The response rate was 42% (55 of 132 surveyed SCARD members). The mean number of productivity indicators used by radiology departments was 4.55 +/- 2.56 (standard deviation), while the mean number of financial indicators used was 2.89 +/- 1.99. Twenty-two (40%) of the 55 responding departments used productivity indicators to monitor and provide feedback to radiologists, hospital leaders, and technical staff members for improved productivity, but only 11 (20%) departments used these indicators to compare personnel performances against specific productivity standards. The most frequent goal (of seven [13%] responding departments) of using the indicators was to increase the examination volume from the previous year by 5%-10%. CONCLUSION: Academic radiology departments across the United States do not use a standardized set of productivity and financial indicators to measure departmental performance. Examination volume is the most frequently used productivity indicator, whereas general expenses are commonly used as indicators of financial status.     

What Characterizes Academic Radiology Departments That Secure Large Amounts of External Funding for Research?

RATIONALE AND OBJECTIVES: We sought to identify factors associated with high levels of external research funding in order to provide departments with information that may help them increase their external research funding. MATERIALS AND METHODS: National Institutes of Health (NIH) data on grants were analyzed to identify the 72 radiology departments receiving funds for diagnostic radiology research. A survey was sent to these departments. We placed them into one of three categories according to total NIH funds to the department. The survey asked about department characteristics such as size; breakdown of full-time faculty among MDs, MD/PhDs, and PhDs; research space; equipment type; and number and types of trainees. RESULTS: Thirty-nine surveys were returned, including 20 from the 21 departments with the most NIH funding. PhDs played a larger role in the most research funding-intensive departments than in others. These departments also were more likely than others to give protected time to all MDs and to devote over 5% of clinical revenues to research, and they had a lower clinical workload per MD. NIH was the source of 70% of their research funding, The role of MD/PhDs and research space per 1000 research dollars did not vary by research intensity. CONCLUSIONS: These findings only demonstrate associations; they do not show the direction of causality. Nonetheless, they suggest what departments need to do if they wish to increase their external research funding.     

<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.     

Results of the 2001 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES: The American Association of Academic Chief Residents in Radiology (A3CR2) conducts an annual survey of residency training programs. The survey data allow comparative analyses to be performed among training programs regarding resident education, benefits, clinical demands, and other resident-related issues. MATERIALS AND METHODS: Questionnaires were mailed to all accredited programs registered in the A3CR2 database (150 total programs). The yearly questions address demographic information concerning the individual programs including academic affiliation, number of radiologic examinations performed per resident, changes in the number of residents per program, and financial compensation. The rotating questions, which are revisited every 4 years, focused on preparation for the American Board of Radiology examinations, educational issues, and employment outlook. RESULTS: Completed surveys were received from 55 programs (37.3%). Among the responses, three issues prevailed: (a) increased number of examinations performed per resident, with resultant decrease in educational time, (b) decreased quality of education in all sections of radiology and decreased number of educational conferences, and (c) improved employment outlook, but continued trend of fewer residents choosing a career in academics. CONCLUSION: The current boom in the radiology job market and the increased number of radiologic examinations performed annually appear to adversely affect radiologic education through a decreased number of conferences and an increased number of radiologic examinations performed per resident.     

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.     

Training in obstetric sonography for radiology residents and fellows in the United States

OBJECTIVE: The purpose of our study was to assess the current experience of radiology residents and fellows in obstetric sonography. SUBJECTS AND METHODS: Written surveys were sent to the directors of 206 accredited radiology residency programs and 85 fellowship programs in the United States. The surveys encompassed obstetric sonographic experience during routine working hours and after hours, the level of supervision, the types of scanning performed, and the extent of formal lectures available during training. Additional questions concerned the relative knowledge of laboratory accreditation processes and training of faculty covering obstetric sonography. RESULTS: Sixty (29%) of 206 accredited radiology residency programs and 24 (28%) of 85 fellowship programs returned surveys. The experience among residency programs was similar, providing fewer than 4 weeks per year of obstetric sonography, usually within their own department of radiology. Residents were more likely to be sent to outside departments for second or third trimester sonography experience. A decrease in scanning assistance was reported for examinations performed after hours, more so for second or third trimester studies. Lecture topics revealed similar deficiencies for residency and fellowship programs. CONCLUSION: Greater emphasis on the performance of prenatal sonographic examinations may be warranted during formal sonography rotations. Current levels of experience in obstetric sonography may not be providing sufficient experience to allow residents to appropriately manage call cases or for practicing radiologists to provide such services after their training is completed.     

Emergency department coverage by academic departments of radiology

RATIONALE AND OBJECTIVES: The purpose of this study was to survey academic radiology departments to determine how emergency radiology coverage is handled and whether there are any prerequisites for those individuals providing this coverage. MATERIALS AND METHODS: The authors developed a simple two-page survey and sent it to a total of 608 program directors, chiefs of diagnostic radiology, chairpersons, and chief residents at academic departments of radiology. RESULTS: Of the 608 surveys sent, 278 (46%) were returned. More than half of the departments have an emergency radiology section that provides "wet read" coverage during the day, and most academic departments cover the emergency department during the night and on weekends. Nighttime and weekend coverage is handled mostly by residents. Most departments give time off for lunch, with few other prerequisites for faculty who provide emergency coverage. Sixty percent of the departments have teleradiology capability, and many use it for emergency department coverage. CONCLUSION: These results can serve as the basis for discussion and comparison with other institutions regarding a variety of aspects of emergency department coverage.     

Radiology residency call in the northeastern United States: comparison of difficulty and frequency in programs of different size

RATIONALE AND OBJECTIVES: The purpose of this study was to develop objective measures of residency call frequency and difficulty, to establish mean values for the northeastern United States, and to test those values for correlation with program size. MATERIALS AND METHODS: A survey questionnaire was sent to 104 radiology residency programs in the northeastern United States. The programs were classified according to number of residents, as small (< 11 residents), medium-sized (11-20 residents), large (21-30 residents), or very large (> or = 31 residents). The call difficulty index was defined as the number of emergency examinations per resident per year. Call frequency indexes were defined as the numbers of evenings and of nights during the 4-year residency when residents were scheduled for call. RESULTS: The average call difficulty index and standard deviation for the respondent programs was 3,855 +/- 1,779. The average call frequency index and standard deviation for evenings was 140 +/- 53 and for nights was 120 +/- 59. A significant negative correlation was found between program size on one hand and call difficulty index (r = -0.36, P = .01), evening call frequency index (r = -0.29, P = .033), and night call frequency index (r = -0.51, P < .001) on the other. Residents in small programs could expect to be on call 192 evenings and 192 nights in the 4-year residency and to perform 4,866 emergency examinations per year, as opposed to the 110 evenings and 89 nights on call and the 3,213 emergency examinations that residents in very large programs could expect. In other words, the smaller the program, the more calls residents can expect to take, and the more emergency examinations they will interpret. CONCLUSION: The mean call difficulty and off-hours call frequency indexes established for residency programs of different size in the Northeast demonstrate increasing call difficulty and increasing off-hours call frequency with decreasing program size.     

Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways

ObjectiveAs of June 30, 2020, interventional radiology (IR) fellowships will cease to exist and will be replaced by the integrated IR, independent IR, and early specialization in IR (ESIR) pathways. The objective of this study is to determine the alignment in the number of available positions between the ESIR and independent IR pathways.MethodsAn analysis was performed of 150 residency programs offering at least 1 of the 3 IR training pathways. Information regarding the most up-to-date list for integrated IR, independent IR, ESIR, and IR fellowship programs were obtained from the Society of Interventional Radiology (SIR), the Electronic Residency Application Service (ERAS), and the Accreditation Council for Graduate Medical Education (ACGME) websites. A 4-question survey was distributed to residency program directors and residency program coordinators to confirm the number of positions offered in each of the training pathways at their institution.ResultsNinety-nine of 113 ESIR programs (87.6% response rate) reported a total of 176 approved ESIR positions. One hundred and eleven fellowship programs in the United States currently offer a total of 331 positions. Seventy-seven integrated IR programs and 48 independent IR programs offer 150 and 133 positions, respectively, for a total of 283 advanced IR training positions.DiscussionA substantial discrepancy currently exists with IR training pathways, as the number of available ESIR positions far outnumbers the available independent IR pathway positions. There is a continuing need for communication with residency programs and frequent reevaluation of the various IR training pathways to maintain the most accurate database.     

Perceptions of required advanced skills

CONTEXT: An electronic survey was conducted to identify the most important nonclinical skills currently required of radiologic technologists to better prepare baccalaureate radiography graduates to meet workplace demands. RESULTS: Survey results of American Healthcare Radiology Administrators (AHRA) members in the Midwestern United States indicate that skills pertaining to departmental systems and human resources administration are of greatest importance, regardless of geographic location. CONCLUSION: An emphasis on medical informatics, diversity and health care communication would benefit both radiography graduates and radiology departments.     

Canadian and American Emergency Radiology Fellowship Websites: An Evaluation of Content

PurposeThe internet is commonly employed by Radiology trainees to investigate and learn about potential fellowship programs. As a new and emerging subspecialty, Emergency Radiology requires strong internet presence and training program website content. This is vital to ensure good exposure of the fellowship programs to inform medical students, radiology trainees, and program directors, highlight unique aspects of a fellowship and raise awareness of the discipline at large.MethodsTo assess the standard and depth of information available online, Canadian and American Radiology fellowship websites were evaluated for content. Thirty-six criteria related to application process and recruitment, departmental structure, incentives, education, and research and clinical training were evaluated for presence or absence.ResultsSixteen Emergency Radiology fellowship program websites were assessed from the United States and Canada for 36 criteria across 5 individual areas; application process and recruitment, departmental structure, incentives, education and research, and clinical training. Overall there was an absence of information found across all 5 areas. In particular areas for improvement were identified in education and research, and incentives both with median values of 12.5% of criteria present.ConclusionMost Emergency Radiology fellowship program websites demonstrate several information deficiencies. This relative lack of comprehensive information represents an actionable opportunity for individual programs and the field to better educate trainees, program directors and the public about the unique training of Emergency Radiologists.     

Out of the Basement and Into the Classroom: Pathways for Expanding the Role of Radiation Oncologists in Medical Student Education

PurposeTo characterize radiation oncologist involvement in undergraduate medical education at US academic medical centers and to incorporate these findings into practical pathways for greater and broader integration of radiation oncology (RO) into medical curricula.MethodsChairpersons and residency program directors at RO departments directly affiliated with a medical school were asked to describe all the ways in which radiation oncologists in their department are involved in medical student education, excluding their elective clerkship.ResultsOf 75 eligible departments, 49 responded (response rate 65.3%). Twenty departments (40.8%) reported that at least one faculty member participates in a curricular educational session on an oncology-related topic. Twelve (24.5%) of these sessions were focused specifically on RO. Twenty-one departments (42.9%) had faculty involved with organized clinical shadowing or preceptorship programs for first- and second-year medical students. Twelve departments (24.5%) described no involvement in the formal curricula at their local or affiliated medical school. Thirteen departments (44.8%) described participation in a medical school–organized residency fair, and 12 departments (41.4%) sponsor an RO interest group. Reported novel approaches to teaching included development of multidisciplinary clerkships or educational sessions that include RO concepts, guest lectures on RO during a required clerkship, organized extracurricular experiences such as an oncology seminar series, participation in special medical student enrichment programs, and sponsorship or initiation of an RO interest group.ConclusionThe minority of RO departments are involved in formal teaching of the medical student body at large. The approaches described herein should facilitate more robust involvement of radiation oncologists in all areas of undergraduate medical education.     

Results of the 2004 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 (A3CR2) conducts a survey of the chief residents in accredited radiology programs in the United States and Canada. The purpose of the survey is to evaluate current residents' opinions regarding a number of different issues pertaining to their educational experience, work responsibilities, and benefits. This information is useful in monitoring patterns of change in resident attitudes toward their experiences within their residency training programs. MATERIALS AND METHODS: Online surveys were made available to the chief residents from 193 training programs in North America. For the most part, the questions were presented in a multiple-choice format, with additional space for elaboration or comments provided for many of the items. Some questions are repeated annually, addressing general topics such as salary and hospital size. However, new questions are incorporated each year. In particular, this year's survey included questions pertaining to Armed Forces Institute of Pathology course funding, and advanced cardiac life support (ACLS) /basic life support certification and changes in duty work hour and call requirements in the face of changing ACGME (Accreditation Council for Graduate Medical Education) regulations. RESULTS: The results of the survey were then tabulated, and responses to several of the repeated questions were compared with those from prior surveys dating back to 1996. This year's response rate was 55%, with 106 unique responses received. This represents an improvement since last year's survey, when the response rate was 41%. In some cases, more than one response was generated by a given residency program, in which case the questionnaire that was more thoroughly completed was used for statistical analysis. Responses were received from chief residents in 37 states and in Canada. The largest number of respondents was from New York, and 80% percent of respondents were from programs affiliated with a university. Forty-two percent were incoming chief residents with less than 3 months' experience, whereas 58% were outgoing chief residents with less than 9 months remaining in their tenure. CONCLUSION: The majority of respondents report that changes made by their respective programs as the result of new ACGME maximum duty hour standards have been viewed favorably by radiology residents. Many training programs have moved toward a night float based call system in order to maintain compliance. Nearly all programs have overnight in-house radiology resident coverage, but there has been a slight decline in the percentage of programs that provide in-house attending coverage at night. The majority of residents, however, have access to attendings after-hours by pager. Finally, resident salaries and benefits continue to increase, as has been the trend over the past several years.