The Influence of Extracurricular Activities on Radiology Resident Selection Decisions.

PURPOSE: Extracurricular activities (EAs) listed on radiology residency applications can signal traits and characteristics desired in holistic reviews. The authors conducted an objective analysis to determine the influence of EAs on resident selection decisions. METHODS: A discrete-choice experiment was designed to model radiology resident selection and determine the relative weights of EAs among academic and demographic application factors. Faculty members involved in resident selection at 30 US radiology programs chose between hypothetical pairs of applicant profiles between October 2021 and February 2022. Each applicant profile included one of 22 EAs chosen for study. A conditional logistic regression model assessed the relative weights of the attributes and odds ratios (ORs) were calculated. RESULTS: Two hundred forty-four participants completed the exercise. Community-service EAs were ranked most highly by participants. LGBTQ Pride Alliance (OR, 1.56; 95% confidence interval [CI], 1.14-2.15; P = .006) and Young Republicans (OR, 0.60; 95% CI, 0.43-0.82; P = .001) significantly influenced decisions. The highest ranked EAs were significantly preferred over the lowest ranked EAs (OR, 1.916; 95% CI, 1.671-2.197; P < .001). Participants preferred EAs that reflected active over passive engagement (OR, 1.154; 95% CI, 1.022-1.304; P = .021) and progressive over conservative ideology (OR, 1.280; 95% CI, 1.133-1.447; P < .001). Participants who ranked progressive EAs more highly preferred applicants with progressive EAs (P < .05 for all). CONCLUSIONS: The influence of EAs on resident selection decisions is significant and likely to gain importance in resident selection as medical student performance metrics are further eliminated. Applicants and selection committees should consider this influence and the bias that EAs can bring to resident selection decisions.

For the Birds: Radiology Parallels, Finding Wellness, and Lessons Learned in Birding.

The popularity of birding has grown substantially during the COVID-19 pandemic. As an activity that can be performed year-round with social distancing in virtually any location, birding shares a striking resemblance to the practice of radiology - so much so that we feel it represents a unique wellness activity that may greatly appeal to radiologists. In this paper, we describe commonalities between birding and radiology, hopefully inspiring readers to get outdoors and commune with nature in this restorative wellness activity.

Can the use of deception be justified in medical education research? A point/counterpoint and case study.

Deception is a common feature of behavioral research design, although not commonly employed in the medical literature. It can promote scientific validity but is ethically controversial because it compromises subject autonomy and incurs additional costs.  In this Point/Counterpoint monograph, we review the nature of deception in research and present arguments for and against its ethical use as a research methodology in behavioral studies.  We describe the necessary guidelines, safeguards, and oversight, when deceptive methodology is considered, and report our experiences and lessons learned from conducting a multi-institutional audit study that relied upon deception of academic radiology faculty.

Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment.

OBJECTIVES: Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. METHODS: A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. RESULTS: There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. DISCUSSION: When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.

You're Biased! Deal With It.

Widespread implementation of the Implicit Association Test has revealed that most doctors, and many radiologists, hold implicit racial bias. Because implicit bias is thought to drive discrimination, it has emerged as a primary explanation for radiology's ongoing racial disparity. In this critical review of the literature, which includes empirical studies of radiology resident selection, the authors argue that implicit bias is a universal human instinctual characteristic, but one that humans have the capacity to override through more deliberative thought processes. Overstating the validity of the Implicit Association Test, and the role of implicit bias in causing radiology's racial disparities, is unwarranted, unhelpful, and potentially distracting from addressing actual causes and real solutions.

PET and SPECT Imaging of Brain Neoplasia Mimics.

Several non-neoplastic processes, including infection, inflammation, demyelination, vasculitis, autoimmune disease, and post-treatment changes (radiation therapy or chemoradiation) can result in a mass-like, space-occupying lesion on conventional computed tomography (CT) or magnetic resonance (MR) imaging of the brain. Additionally, non-neoplastic processes can produce imaging findings that mimic nontumoral neoplastic involvement of the central nervous system. Such instances pose a substantial diagnostic dilemma for interpreting radiologists, as well as clinicians tasked with determining the appropriate diagnostic tests and therapeutic strategies for these patients. Nuclear medicine studies, including single positron emission computed tomography (SPECT) and positron emission tomography (PET), as well as hybrid SPECT/CT, PET/CT, and PET/MRI may offer important diagnostic insights into these challenging cases, often helping to differentiate these mimics from true brain neoplasms. In this review, we detail common and uncommon brain tumor mimics in specific context of PET and SPECT imaging of the brain, including the multimodality imaging appearance of tumor mimics and the potential roles these modalities may play in providing diagnostic clarity.

Diffusion MR Imaging in the Head and Neck: Principles and Applications.

Diffusion imaging is a functional MR imaging tool that creates tissue contrast representative of the random, microscopic translational motion of water molecules within human body tissues. Long considered a cornerstone MR imaging sequence for brain imaging, diffusion-weighted imaging (DWI) increasingly is used for head and neck imaging. This review reports the current state of diffusion techniques for head and neck imaging, including conventional DWI, DWI trace with apparent diffusion coefficient map, diffusion tensor imaging, intravoxel incoherent motion, and diffusion kurtosis imaging. This article describes background physics, reports supportive evidence and potential pitfalls, highlights technical advances, and details practical clinical applications.

An Institutional Academic and Research Track Curriculum for Radiology Residents: Development, Implementation, and Outcomes Assessment at 6 Years.

RATIONALE AND OBJECTIVES: We report the creation of a voluntary research development curriculum for radiology residents at our institution, detailing outcomes after 6 years of existence. MATERIALS AND METHODS: We developed a comprehensive Academic and Research Track (ART) curriculum for radiology residents in our department, including mentorship, monthly meetings, didactic curriculum, ongoing evaluation/feedback, protected academic time, and financial support. A literature review identified all indexed publications for our residency graduates from 6 years pre- (2007-2012) to 6 years post-ART (2013-2018) intervention. We also documented career outcomes (academic versus private practice). Summary statistics, Chi-square, and Poisson regression analyses were performed. RESULTS: ART group demonstrated significantly greater publication likelihood versus pre-ART predecessors (odds ratio [OR]: 3.59, 95% confidence intervals [CI]: 1.40-9.19; risk ratios [RR]: 1.58, 95% CI: 1.19-2.11; p= 0.01), contemporaneous non-ART cohort (OR: 3.03, 95% CI: 1.12-8.33; RR: 1.45, 95% CI: 1.08-1.96; p = 0.04), and combined pre-ART plus non-ART group (OR: 3.34, 95% CI: 1.35-8.22; RR: 1.41, 95% CI: 0.87-2.29; p = 0.012). In Poisson regression, ART was a significant factor for total, first author, and senior author publications among all graduates and among the subset which remained in academics (all p-values < 0.05). Estimators were positive in all regressions, indicating a positive effect of ART for increasing numbers of publications. CONCLUSION: ART membership was associated with significantly increased indexed publications. A greater proportion of ART members remained in academics compared to non-ART members, but did not reach statistical significance. We detail our ART structure and curriculum, which may be used as a malleable template for other radiology departments.

Awareness of implicit bias mitigates discrimination in radiology resident selection.

OBJECTIVES: Implicit bias is common and is thought to drive discriminatory behaviour. Having previously demonstrated discrimination against specific applicant demographics by academic radiology departments in a simulated resident selection process, the authors sought to better understand the relationship between implicit bias and discrimination, as well as the potential and mechanisms for their mitigation. METHODS: A total of 51 faculty reviewers at three academic radiology departments, who had participated in a 2017 audit study in which they were shown to treat applicants differently based on race or ethnicity and physical appearance, were invited to complete testing for implicit racial and weight bias using the Implicit Association Test in 2019. Respondents were also surveyed regarding awareness of their own personal racial and weight biases, as well as any prior participation in formal diversity training. Comparisons were made between implicit bias scores and applicant ratings, as well as between diversity training and self-awareness of bias. RESULTS: A total of 31 out of 51 faculty reviewers (61%) completed and submitted results of race and weight Implicit Association Tests. A total of 74% (23/31) reported implicit anti-obese bias, concordant with discrimination demonstrated in the resident selection simulation, in which obese applicants were rated 0.40 standard deviations (SDs) lower than non-obese applicants (P < .001). A total of 71% (22/31) reported implicit anti-Black bias, discordant with application ratings, which were 0.47 SDs higher for Black than for White applicants (P < .001). A total of 84% (26/31) of participants reported feeling self-aware of potential racial bias at the time of application review, significantly higher than the 23% (7/31) reporting self-awareness of potential anti-obese bias (P < .001). Participation in formal diversity training was not associated with implicit anti-Black or anti-fat bias, nor with self-reported awareness of potential racial or weight-based bias (all P > .2). CONCLUSIONS: These findings suggest that implicit bias, as measured by the Implicit Association Test, does not inevitably lead to discrimination, and that personal awareness of implicit biases may allow their mitigation.

Normal Patterns and Pitfalls of FDG Uptake in the Head and Neck.

In order to avoid misdiagnoses, medical imagers should be familiar with the normal patterns and distribution of fluorodeoxyglucose (FDG) activity within the head and neck, as well as the pathophysiology and imaging-findings of common diagnostic pitfalls related to incidental FDG-avid lesions. The purpose of this article is to provide an image-rich review of the normal patterns of FDG uptake in the head and neck, help differentiate benign from malignant incidentally found FDG-avid foci, and detail important "don't miss" hypometabolic head and neck lesions on positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging.

Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive?

PURPOSE: To evaluate for appearance-based discrimination in the selection of radiology residents. METHOD: A deception study simulating the resident selection process examined the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from 5 academic radiology departments reviewed mock residency applications in September and October 2017. Each application included demographic information and a photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed- and random-effects models. RESULTS: Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive vs unattractive, B = 0.30 [SE = 0.056]; neutral vs unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (vs not obese) (B = -0.14 [SE = 0.024]). CONCLUSIONS: Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.

Spinal Manifestations of Systemic Disease.

The spine is frequently involved in systemic diseases, including those with neuropathic, infectious, inflammatory, rheumatologic, metabolic, and neoplastic etiologies. This article provides an overview of systemic disorders that may affect the spine, which can be subdivided into disorders predominantly involving the musculoskeletal system (including bones, joints, disks, muscles, and tendons) versus those predominantly involving the nervous system. By identifying the predominant pattern of spine involvement, a succinct, appropriate differential diagnosis can be generated. The importance of reviewing the medical record, as well as prior medical imaging (including nonspine imaging), which may confer greater specificity to the differential diagnosis, is stressed.

Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year.

RATIONALE AND OBJECTIVES: We report the development of a new "Case of the Day" (COTD) educational initiative using email, social media (SoMe), and a website to disseminate content, as well as its trends in viewership and assessment of utility for the first year of implementation. MATERIALS/METHODS: Using an image-rich format, a new unknown case was disseminated to radiology trainees and attendings at our institution by email twice per week, including history, salient images, and follow-up questions. Simultaneously, content was externally disseminated on Twitter and a publicly viewable departmental website. On subsequent days, the answer was posted via email, Twitter, and website in the form of a brief YouTube video lecture. Viewership data were collected over the first 12 months (July 1, 2016 to June 30, 2017), and an anonymous survey of participants was performed. RESULTS: Sixty-five COTDs had complete viewership data and were included in our analysis, yielding 4911 "case" email views (mean = 76), 3798 "answer" email views (mean = 58), 68,034 "case" Twitter impressions (mean = 1047), 75,724 "answer" Twitter impressions (mean = 1164), 5465 "case" Twitter engagements (mean = 84), and 5307 "answer" Twitter engagements (mean = 82). COTD YouTube video lectures garnered 3657 views (mean = 61) amounting to 10,358 minutes of total viewing time. Viewers were very satisfied with COTD quality, with 97% (n = 63) reporting the quality as "good" or "excellent." CONCLUSIONS: Email and SoMe can serve as effective tools for disseminating radiology educational content. SoMe offers substantial external visibility and branding potential for programs.

Social Media Utilization at an Academic Radiology Practice.

RATIONALE AND OBJECTIVES: We report social media (SoMe) utilization trends at an academic radiology department, highlighting differences between trainees and faculty and between Baby Boomers versus Generation X and Millennials. MATERIALS AND METHODS: An anonymous online survey regarding SoMe utilization and SoMe-based educational curriculum was distributed to all radiologists (trainees and faculty) in our department. Regular chi-square, ordered (Mantel-Haenszel) chi-square, and Fischer exact tests were performed. RESULTS: The survey instrument was sent to 172 radiologists with a 65% completion rate (N = 112). Eighty-three percent (n = 92) of the respondents use SoMe, with Facebook (67%, n = 75), YouTube (57%, n = 64), Instagram (26%, n = 29), and Twitter (21%, n = 23) as the most commonly used platforms. Eighty-one percent (n = 91) use SoMe for 30 minutes or less per day. Thirty-five percent (n = 39) reported previously using SoMe for educational purposes, although 66% (n = 73) would be willing to join SoMe for educational activities. The faculty are more likely than trainees to avoid using SoMe (30% vs 9%, P < 0.03). Trainees are more likely than faculty to find an electronic case-based curriculum valuable (95% vs 83%, P < 0.05) and are willing to spend more time on cases (P < 0.01). Baby Boomers are less interested in joining SoMe for educational activities than Generation X and Millennials (24% vs 73%, P = 0.0001). CONCLUSIONS: Generation gaps between trainees and faculty, as well as between Generation X and Millennials versus Baby Boomers, exist with regard to the use of SoMe, which may be underutilized in radiology education.