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

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

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

Acute Necrotising Pancreatitis Associated with Leptospirosis—A Case Report

Acute Necrotizing Pancreatitis is a rare complication of leptospirosis and this association carries a high mortality rate. Only few cases have been reported in literature. We hereby report one such case we encountered.     

Synthesis and preliminary evaluation of difluorinated 1,3-propanediones as potential agents in the treatment of breast cancer

A series of difluorinated propanediones were synthesized and evaluated for in vitro cytotoxic activity by Sulforhodamine B (SRB) assay against a panel of four human cancer cell lines. Though the compounds showed varying degrees of cytotoxicity in the tested cell lines, most marked effect was observed in breast cancer cell line (MCF7), wherein nine of the ten synthesized chalcones showed good antiproliferative activity.     

Plant thorn synovitis of elbow in children

Four rare cases of plant thorn synovitis of left elbow were admitted at our institution, which were initially misdiagnosed as partially treated septic arthritis of elbow or Juvenile inflammatory arthritis. All of them were of paediatric age group. Symptoms included pain, swelling, and decreased range of motion of affected joint. On examination synovitis was present in all patients.Roentgenograms & Ultrasonography were inconclusive in all patients, Definitive diagnosis was made only after arthrotomy, Thorn fragments (Acacia arabica) were recovered from the hypertrophied synovium & subtotal synovectomy was done and sent for histopathological examination. All patients improved after surgery with mean residual flexion deformity of 12.5 ± 2.86°. Plant thorn induced synovitis of elbow is rare, it must be included in the differential diagnosis of monoarthritis of elbow and a high index of suspicion is needed for retained thorn fragments in elbow joint causing synovitis. Its optimal treatment is arthrotomy, foreign body removal and total/subtotal synovectomy.