Differential Motivations for Pursuing Interventional Radiology: Implications for Residency Recruitment

Purpose

The purpose of this study is to compare the motivations of interventional radiology (IR) residency, IR fellowship, and diagnostic radiology (DR) applicants.

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.     

Design,Implementation, and Evaluation of a Diversity Program for Radiology

Rationale and ObjectivesDiagnostic radiology training programs are less diverse than graduating US medical school classes and the patient populations they serve. Inclusion of physicians who are underrepresented minorities in medicine (URMM) can strengthen the profession and help to meet the needs of an increasingly diverse population. Our Department of Radiology developed and implemented a plan to increase the number of URMMs in our residency applicant pool and residency training program.Materials and MethodsWe designed a recruitment strategy to diversify the radiology residency applicant pool. This included website development, advertising, early exposure opportunities, travel to predominantly minority institutions and national meetings, and mentoring URMM medical students. We implemented parallel activities to increase the number of URMMs in our residency program. These included holistic screening tools for residency application review, a diverse residency recruitment committee, a welcome environment for visiting candidates, and “Second Look Weekend” visits for talented candidates. Primary outcomes measured include change in percentages of URMM applicants in our applicant pool and URMM residents in our residency program.ResultsThe percentage of URMM radiology residency applicants increased from 7.5% (42 of 556) of the total applicant pool in the 2012 to 2013 recruitment year to 12.6% (98 of 777) in the 2017 to 2018 recruitment year (P = .001). URMM radiology residency representation increased from 0% (0 of 32) in the 2013 to 2014 academic year to 20% (6 of 30) in the 2018 to 2019 academic year (P = .01).ConclusionAn intentional, strategic diversity program can diversify an institution’s residency applicant pool and increase representation of URMMs in a diagnostic radiology residency program.     

Descriptive analysis of interventional radiology residency program directors in the United States

PurposeTo analyze the academic background, demographics and scholarly metrics of Interventional Radiology (IR) residency program directors (PDs) in the United States.MethodsOnline search of publicly available resources was performed from April 6–10, 2020. PDs and associate PDs of ACGME accredited integrated and independent IR residency programs were included in the study. The variables collected from publicly available sources included age, sex, academic background (including medical school, residency and fellowship), and scholarly activity (publications, citations and h-index). Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups.ResultsA total of 174 PDs and associate PDs from 110 unique integrated and independent IR residency programs were included in the study. One hundred fifty three (87.9%) were male and twenty one (12.1%) were female. The average age of PDs was 47.39 years (SD 8.99, median 45, range 34–74). Eighty six percent of the PDs were American medical school graduates, 97% received a MD degree or foreign equivalent, and 3% received a DO degree. There was no statistical difference between male and female PDs with regards to number of publications, average number of citations or mean h-index. Fellow of the Society of Interventional Radiology (FSIR) qualification was held by 21.3% and PDs with FSIR designation had significantly higher scholarly metrics.ConclusionIR Residency PDs are predominantly male and graduates of American medical schools. Women represent only 12% of the IR PD workforce with no significant difference in scholarly metrics of female PDs compared to male PDs. PDs with FSIR designation had significantly higher scholarly metrics.     

Assessment of US Radiology Residency Program Websites in the COVID-19 Era

ObjectiveTo provide an updated evaluation of radiology residency program websites in light of virtual interviewing during the COVID-19 pandemic and encourage programs to improve the quality of their online website presence.MethodsWe evaluated the websites of 197 US radiology residency programs between November and December 2021 for the presence or absence of 30 metrics. The metrics chosen are those considered important by applicants when choosing a program and have been used in other similar papers.ResultsOf the 197 programs, 192 (97.5%) had working websites. The average radiology residency website had 16 of 30 (54%) metrics listed on their websites. Five programs did not have accessible websites and were not included in the analysis. The most comprehensive website had 29 of 30 (97%) of metrics listed and the least comprehensive website had 2 of 30 (7%). There is a statistically significant difference in website comprehensiveness between top 20 and non–top 20 radiology program websites.ConclusionAlthough radiology residency program websites have generally become more comprehensive over time, there is still room for improvement, especially in times of virtual interviews when residency applicants are becoming more and more reliant on program websites to gain essential information about a program. Some key areas to include are diversity and inclusion initiatives, resident wellness, applicant information, program benefits, and showcase of people in the program.     

Prospects of a Fellowship Match for Abdominal Imaging: A National Survey by the Society of Abdominal Radiology

PurposeAfter the Society of Chairs of Academic Radiology Departments timeline and guidelines were released for the 2021 through 2022 fellowship application cycle, the Society of Abdominal Radiology conducted a survey of residents, fellows, and abdominal imaging fellowship program directors (PDs) to assess stakeholders’ perceptions of changes in the fellowship application process.MethodsEligible study participants included fellowship PDs of all US abdominal imaging programs and Society of Abdominal Radiology members-in-training. A questionnaire was developed by content and survey experts, pilot-tested, and administered from August to October 2019.ResultsSurvey response rates were 51.4% among PDs (54 of 103) and 24.2% among trainees (67 of 279), with an overall response rate of 31.8%. Attitudes regarding the abdominal imaging fellowship application process were overall similar between PDs and trainees, including expressed support for a common application. Although trainees and PDs agreed that the Society of Chairs of Academic Radiology Departments 2021 through 2022 cycle timeline is preferable to the prior unstructured system, only 42.4% of PDs and 40.7% of trainees supported moving to a formal match, with a significant number of respondents undecided. Both PDs and trainees favored timing fellowship interviews during the fall of the third year of residency (R3 year), with a 1- to 2-month buffer between the start of interviews and offers.ConclusionsPDs and trainees demonstrate similar attitudes in support of the Society of Chairs of Academic Radiology Departments 2021 through 2022 cycle timeline and a common abdominal imaging fellowship application. Shifting the interview season from winter to fall of R3 year could be considered to meet the preferences of PDs and trainees alike. Moving to a formal match remains controversial.     

Regional Variations in Diagnostic Radiology Residency Stipends Are Accentuated When Correlated With Cost of Living

ObjectivesTo determine and compare the relative value of diagnostic radiology resident stipends when adjusted for regional cost of living.MethodsThe ACGME database was queried for a list of accredited allopathic diagnostic radiology residency programs for academic year 2017-2018. Stipend information for R1 positions (post-graduate year 2) was identified through each program's website. Data was grouped and analyzed by city, state, and geographical region. Stipends were then correlated with the 2017 annual region-specific average cost of living index (COLI).ResultsThere were 194 programs identified, of which 118 (60.8%) were analyzed after exclusions for lack of stipend or corresponding COLI data. The average annual stipend was $57,161±$4,242 (range, $49,547-$72,000). The COLI-adjusted value was $51,357±$9,927 (range, $26,915-$68,827). The average difference between stipend and cost-ofliving adjusted value was -$5,804±$12,610 (range, -$40,953-$10,958), corresponding to an average -9.1% stipend value loss (range, -58.1%-21.7%, P = .00000004). Value loss in large metropolitan cities was as high as 53.8%.DiscussionFinancial issues are one of the biggest challenges faced by trainees and have been correlated with increased stress as well as poor academic performance. The pressures of debt can also play a significant role in ultimate subspecialty career choice. Discrepancies between resident stipends, which are not adjusted based on the local COLI, are exacerbated by large regional variations in cost of living. Residency applicants should not discount regional cost of living when deciding where to train, and training programs should consider cost of living when setting stipend levels for their trainees.     

Radiology resident selection factors predict resident performance

PurposeTo determine selection factors that predict radiology resident performance.Methods59 consecutive radiology residents from 2002 to 2015 were ranked on performance during residency. Correlations and multiple regression analyses were performed to predict resident performance from the following selection factors: United States Medical Licensing Exam (USMLE) Step 1 score, medical school rank, Alpha Omega Alpha (AOA) membership, honors in clinical rotations, Medical Student Performance Evaluation (MSPE), and interview score. Results were compared against predictions from Match rank position.ResultsFive selection factors showed significant or marginally significant correlations with resident performance (r = 0.2 to 0.3). The interview score was not significantly correlated. A multiple regression model comprised of the USMLE Step 1 score, medical school rank, AOA membership, and interview score predicted resident performance, with an adjusted R² of 0.19. The interview score was included in the model but did not achieve statistical significance. Match rank did not predict resident performance, with an R² of 0.01.ConclusionsA multiple regression model comprised of the USMLE Step 1 score, medical school rank, and AOA membership predicted radiology resident performance and may assist with resident selection.     

Radiology Clerkship Requirements in Canada and the United States: Current State and Impact on Residency Application

PurposeAn unmet need for radiology education exists even in this era of medical school curricular renewal. The authors examined the radiology clerkship requirements in Canadian and US medical schools to interpret radiology residency applicant trends.MethodsThe curricula of Canadian and US medical schools were reviewed for radiology rotation requirements. The radiology residency applicant trends for 2010 to 2019 were analyzed using linear regression. The number of radiology electives taken by matched radiology applicants was examined. Regression analysis was performed to assess the impact of radiology rotation requirements on residency application.ResultsOnly 1 of 17 Canadian medical schools required a radiology rotation despite major curricular renewal at the majority of medical schools. Approximately 20% of US medical schools required radiology rotations, without a significant change from 2011 to 2018, whereas the duration of required radiology rotations increased significantly. The numbers of total and first-choice radiology applicants showed significant decreases from 2010 to 2019 in Canada but not in the United States. Nearly all matched radiology applicants took electives in radiology, the majority of whom took three or more electives. Both the presence and duration of radiology rotation requirements showed significant, positive relationships with the number of radiology applicants.ConclusionsOnly a minority of medical schools in North America have radiology clerkship requirements, both the presence and duration of which significantly affect students’ choice of radiology as a career. Radiology clerkship requirements can be a solution to meet the expanding demand for diagnostic imaging in modern medicine.     

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.     

Opportunities for Excellence in Interventional Radiology Training: A Qualitative Study

ObjectiveThe training experience in interventional radiology (IR) residency programs varies widely across the country. The introduction of an IR training pathway has provided the impetus for the specialty to better define outstanding IR education and for programs to rethink how their curricula prepare IR trainees for real-world practice. Although ACGME competencies define several training components that are necessary for independent practice, few quantitative or qualitative studies have explored current perceptions on what constitutes optimal IR training. Our goal was to qualitatively explore program training features deemed most important to adequately prepare IR physicians for practice and assess whether there were differences in perception between academic and nonacademic practices.MethodsSemistructured interviews were conducted with 71 IR attending physicians, trainees, and support staff across the United States. All interviews were performed over the telephone by a single researcher for consistency and systematically coded by two independent coders for common themes. Frequency and prevalence of themes and facilitating features were analyzed.ResultsThe most frequently perceived facilitating features included longitudinal patient care experience, practice-building education, interspecialty collaboration exposure, broad case mix, clinical decision-making exposure, diagnostic radiology training, procedural skills training, and graduated autonomy. Comparing nonacademic versus academic practice settings, significantly more nonacademic IR attending physicians expressed practice-building education (prevalence 72% versus 42%, frequency 2.2 versus 0.7, P < .01) as an important training experience.DiscussionAn understanding of perceived facilitating features for optimal IR trainee preparation, including potentially different needs between academic and nonacademic practices, can help programs prepare their trainees for a successful transition into practice.     

An Assessment of Radiology Residency Program Websites

PurposeWhen prospective radiology residents decide where to apply to residency, many will use the Internet as a resource to garner information. Therefore, it is important for residency programs to produce and maintain an informative and comprehensive website. Here, we review 179 radiology residency program websites for 19 criteria including various aspects related to the residency application process, benefits, didactics, research, clinical training, and faculty leadership.MethodsWe evaluated 179 radiology residency program websites for the inclusion of 19 different criteria. Criteria for information not available directly on the website and links with no information were considered not present.ResultsOnly 12 of the 179 (6.7%) program websites had at least 80% of the 19 criteria. In addition, 41 programs (23%) had less than 50% of the criteria listed on their websites. Websites ranged from having 16% of the criteria to as much as 95%.ConclusionAlthough previous studies have shown that prospective radiology resident applicants are influenced by intangibles like current resident satisfaction and academic reputation, they have also shown that applicants are influenced by the educational curriculum, clinical training, program resources, research opportunities, and quality of faculty. Therefore, it is imperative to provide online resources for prospective candidates in an attempt for residency programs to remain competitive in recruiting high-quality US medical student graduates. These findings suggest there is room for improving the comprehensiveness of information provided on radiology residency program websites.     

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.     

Medicare Reimbursement Trends for Interventional Radiology Procedures: 2012 to 2020

PurposeTo investigate the reimbursement trends for interventional radiology (IR) procedures from 2012 to 2020.Materials and MethodsReimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services was compiled for 20 common IR procedures. The authors then investigated compensation trends after adjusting for inflation and from the unadjusted data between 2012 and 2020.ResultsFrom 2012 to 2020, the mean unadjusted reimbursement for procedures decreased by ?6.9% (95% confidence interval [CI], ?13.5% to ?0.34%). This trend was even more profound after inflation was taken into account, with a mean decline in adjusted reimbursement of ?18.7% (95% CI, ?24.4% to ?12.9%) during the study period, with a mean yearly decline of ?2.8%. The difference between the mean unadjusted and adjusted payment amounts was significant (P = .012). Similarly, linear regression analysis of the adjusted average reimbursement across all procedures revealed an overall decline from 2012 to 2020 (R² = 0.97), indicating a steady decline in reimbursement over time.ConclusionsIn just under a decade, IR has experienced significant reimbursement cuts by Medicare, as demonstrated by both the unadjusted and inflation-adjusted payment trends. Knowledge of these trends is critically important for practicing interventional radiologists, leaders within the field, and legislators, who may play a role in formulating future reimbursement schedules for IR. These data may be used to help support more amenable reimbursement plans to sustain and facilitate the growth of the specialty.     

The State of Medical Student Teaching of Interventional Radiology: Implications for the Future

IntroductionThe formation of integrated interventional radiology (IR) residency programs has changed the training paradigm. This change mandates the need to provide adequate exposure to allow students to explore IR as a career option and to allow programs to sufficiently evaluate students. This study aims to highlight the availability of medical student education in IR and proposes a basic framework for clinical rotations.Materials and MethodsThe Liaison Committee on Medical Education (LCME) website was utilized to generate a list of accredited medical schools in the United States. School websites and course listings were searched for availability of IR and diagnostic radiology rotations. The curricula of several well-established IR rotations were examined to identify and categorize course content.ResultsIn all, 140 LCME-accredited medical schools had course information available. Of those schools, 70.5% offered an IR rotation; 84.6% were only available to senior medical students and only 2% were offered for preclinical students; and 8.1% of courses were listed as subinternships. Well-established IR clerkships included a variety of clinical settings, including preprocedure evaluation, experience performing procedures, postprocedure management, and discharge planning.ConclusionMedical student exposure to IR is crucial to the success of integrated IR residency programs. Current research shows few institutions with formal IR subinternship rotations. Although 70.5% of institutions have some form of nonstandardized IR course, 84.6% are available only to fourth-year students, and 2% are offered to preclinical students. This suggests there is a significant opportunity for additional formal exposure to IR through increasing availability of IR rotations and exposure during the clinical and preclinical years.     

Interventional Radiology in China

With more than 3000 members, the Chinese Society of Interventional Radiology (CSIR) is one of the world’s largest societies for interventional radiology (IR). Nevertheless, compared to other societies such as CIRSE and SIR, the CSIR is a relatively young society. In this article, the status of IR in China is described, which includes IR history, structure and patient management, personnel, fellowship, training, modalities, procedures, research, turf battle, and insightful visions for IR from Chinese interventional radiologists. Gao-Jun Teng and Ke Xu contributed equally to this article.     

Completeness of Reporting in Abstracts of Randomized Controlled Trials Assessing Interventional Radiology for Liver Disease

PurposeTo assess the completeness of reporting in abstracts of published randomized controlled trials (RCTs) assessing interventional radiology (IR) for liver disease; to assess whether publication of the 2017 CONSORT update for nonpharmacologic treatments (NPTs) resulted in changes in abstract reporting; and to identify factors associated with better reporting.Materials and MethodsMEDLINE and Embase were searched to identify RCTs of IR for liver disease (January 2015 to September 2020). Two reviewers assessed the completeness of abstract reporting according to the CONSORT-NPT-2017-update. The primary outcome was the mean number of CONSORT items completely reported among 10 items reported in <50% of the abstracts published in 2015. A time series analysis assessed the evolution trend over time. Moreover, a multivariate regression model was used to identify factors associated with better reporting.ResultsA total of 107 abstracts of RCTs published in 61 journals were included. Overall, 74% (45/61) of journals endorsed the main CONSORT guidelines, of which 60% (27/45) had a policy to implement them. The mean number of primary outcome items completely reported increased by 0.19 over the study period. The publication of the CONSORT-NPT update did not lead to an increase in the trend of items reported (increase of 0.04 items/month before vs 0.02 after; P = .41). Factors associated with more complete reporting were impact factor (OR = 1.13; 95% CI: 1.07–1.18) and endorsement of CONSORT with an implementation policy (OR = 8.29; 95% CI: 2.04–33.65).ConclusionsCompleteness of reporting is incomplete in abstracts of trials of IR liver disease and did not improve after publication of the CONSORT-NPT-2017 update with abstract guidance.     

Temporal and geospatial variations among the interventional radiology physician workforce in the United States

ObjectiveTo analyze the temporal trends and state-wide geospatial variations in Vascular and Interventional Radiology (VIR) workforce in the United States.MethodsThe State Physician Workforce Data from the AAMC website was accessed for years 2015, 2017, and 2019. The variables collected for each state included total number of active physicians, total number of physicians per specialty and total number of female physicians in VIR. Comparative data was obtained for vascular surgery (VS), diagnostic radiology (DR), and radiation oncology (RO). The annual growth rate for total physicians and sub-analysis of female physicians in each state was computed for each specialty.ResultsFrom 2015 to 2019, the total number of active physicians in the United States grew by 1.8% per year. Growth of active physicians in VIR grew by 8.3%, DR 0.06%, VS 4.4%, and RO 1.9% per year. Colorado and Minnesota had the highest growth rate for VIR physicians (15%). VIR physicians per 100,000 people increased from 0.84 (2015) to 1.10 (2019) in the US. In comparison, VS physicians increased from 0.99 (2015) to 1.14 (2019), DR physicians decreased from 8.61 (2015) to 8.43 (2019), and RO physicians grew from 1.48 (2015) to 1.56 (2019). Women represented 6.8% of the VIR workforce in the US in 2019 and increased by a rate of 16% annually in the US from 2015 to 2019. In comparison, the number of women in VS has grown by 21%, DR by 2%, and RO by 2.4% during the same period. The state of Maryland has the highest proportion of women in VIR at 18%.ConclusionThe number of VIR physicians is increasing at a higher rate than the national overall physician growth, and while female VIR physicians makeup a small fraction of the VIR workforce, their numbers have increased at a faster rate than overall VIR physicians.     

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.