Learning, technology and intellectual property: a survey of the philosophies and preferences of our trainees and peers.

BACKGROUND: Increasing workloads threaten the quality of teaching in academic radiology practices. There is a wealth of unfiltered educational resources for radiology on the internet. As a digital native, today's radiology trainee may have differing opinions from teachers about learning and intellectual property. OBJECTIVE: To identify the preferences and philosophies regarding learning, technology and intellectual property toward the future development of an innovative radiology curriculum. MATERIALS AND METHODS: An electronic survey with 22 questions was sent to 2,010 members of the Society for Pediatric Radiology and 100 radiology trainees. RESULTS: Three hundred sixty-one of the 2,110 surveys were returned. All questions were completed in 342 surveys. Fifty-three respondents were trainees (residents and fellows) and 289 respondents were radiologists (teachers). Time needed for a single learning activity in both groups is <30 min, but teachers spend less time (P=0.007). The preferred learning environments were point-of-care and outside work hours for both groups. Ideal lecture durations were 31-45 min for trainees and 21-30 min for teachers (P=0.001). Adoption of new technology showed late majority and laggard trends for both groups (P=0.296). Interest in gadgets was greater in trainees (17%) than teachers (2%) (P<0.001). Interest in lecture recording was greater in trainees (84%) than teachers (61%) (P=0.008). More trainees (61%) than teachers (42%) would not charge money for educational materials (P=0.028); 27% versus 13%, respectively, disagreed with dissemination of those materials beyond the institution (P=0.013). CONCLUSION: While millennial trainees are adult learners with a stronger comfort with technology, learning styles of trainees and teachers are more similar than was previously believed. Trainees and teachers hold conflicting philosophies about intellectual property. Results herein speak favorably for revising our teaching portfolio to include practical learning materials of short duration available at point-of-care.

Transoral robotic surgery in head and neck cancer: what radiologists need to know about the cutting edge.

The evolution of oncologic surgical technology has moved toward reducing patient morbidity and mortality without compromising oncologic resection or oncologic outcomes. The goals in treating head and neck cancer are to cure patients, as well as to provide quality of life by improving functional and social outcomes through organ-preservation therapies, which may include surgery, chemotherapy, and/or radiation therapy. Transoral robotic surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens and over open surgery for head and neck cancer, including reductions in operative times, blood loss, intensive care unit stays, and overall duration of patient hospitalization. Transoral robotic techniques allow wide-view, high-resolution, magnified three-dimensional optics for visualization of the mucosal surfaces of the head and neck through an endoscope, while avoiding the extensive external cervical incisions often required for open surgeries. Radiologists play an important role in the successful outcome of these procedures, both before and after TORS. Determining a cancer patient's surgical candidacy for TORS requires a thorough preoperative radiologic evaluation, coupled with clinical and intraoperative assessment. Radiologists must pay particular attention to important anatomic landmarks that are clinical blind spots for surgeons. Knowledge of the expected postoperative imaging appearances, so that they can be distinguished from recurrent disease and second primary tumors, is essential for all radiologists involved in the care of these patients.

Summary of the 2022 ACR Intersociety Meeting.

The ACR Intersociety Committee meeting of 2022 (ISC-2022) was convened around the theme of "Recovering From The Great Resignation, Moral Injury and Other Stressors: Rebuilding Radiology for a Robust Future." Representatives from 29 radiology organizations, including all radiology subspecialties, radiation oncology, and medical physics, as well as academic and private practice radiologists, met for 3 days in early August in Park City, Utah, to search for solutions to the most pressing problems facing the specialty of radiology in 2022. Of these, the mismatch between the clinical workload and the available radiologist workforce was foremost-as many other identifiable problems flowed downstream from this, including high job turnover, lack of time for teaching and research, radiologist burnout, and moral injury.

Using focused missed-case conferences to reduce discrepancies in musculoskeletal studies interpreted by residents on call.

OBJECTIVE: The purpose of this study is to determine whether focused missed-case conferences can significantly reduce the number of major discrepancies in musculoskeletal imaging studies interpreted by residents on call. MATERIALS AND METHODS: A review of major discrepancies in musculoskeletal conventional radiography imaging studies interpreted by radiology residents and fellows on call from July 2008 to July 2009 revealed 31 common and important musculoskeletal injuries missed or misinterpreted at our institution. These missed cases were presented during focused missed-case conferences from July through October 2009. Only residents attended missed-case conferences. RESULTS: Over the 12 months before the missed-case conferences, there were 55 resident major discrepancies and 25 fellow major discrepancies, representing 31 common and important missed musculoskeletal injuries. Over the 12 months after the missed-case conferences, there were 18 resident major discrepancies and 21 fellow major discrepancies involving these injuries. This corresponds to a 67% reduction in the number of resident major discrepancies involving the 31 musculoskeletal injuries covered during the missed-case conferences (chi-square p < 0.001). The overall major discrepancy rate for all musculoskeletal conventional radiography studies was 1.19% for residents and 1.55% for fellows (not significant) before the missed-case conferences and 0.87% for residents and 1.46% for fellows (p < 0.05) after the missed-case conferences. During this time, fellows missed more musculoskeletal injuries related to the topics discussed during missed-case conferences (16) compared with residents (8) although fellows read significantly fewer studies overall. This accounted for 0.49% of the 0.59% difference between residents and fellows. CONCLUSION: Focused missed-case conferences are an effective educational intervention to significantly reduce the number of major discrepancies in radiology resident interpretation of musculoskeletal imaging studies on call.

Orion: a web-based application designed to monitor resident and fellow performance on-call.

Radiology residency and fellowship training provides a unique opportunity to evaluate trainee performance and determine the impact of various educational interventions. We have developed a simple software application (Orion) using open-source tools to facilitate the identification and monitoring of resident and fellow discrepancies in on-call preliminary reports. Over a 6-month period, 19,200 on-call studies were interpreted by 20 radiology residents, and 13,953 on-call studies were interpreted by 25 board-certified radiology fellows representing eight subspecialties. Using standard review macros during faculty interpretation, each of these reports was classified as "agreement", "minor discrepancy", and "major discrepancy" based on the potential to impact patient management or outcome. Major discrepancy rates were used to establish benchmarks for resident and fellow performance by year of training, modality, and subspecialty, and to identify residents and fellows demonstrating a significantly higher major discrepancy rate compared with their classmates. Trends in discrepancies were used to identify subspecialty-specific areas of increased major discrepancy rates in an effort to tailor the didactic and case-based curriculum. A series of missed-case conferences were developed based on trends in discrepancies, and the impact of these conferences is currently being evaluated. Orion is a powerful information technology tool that can be used by residency program directors, fellowship programs directors, residents, and fellows to improve radiology education and training.

Preliminary Radiology Report Discordances and Patient Outcomes.

RATIONALE AND OBJECTIVES: At our institution, resident and fellow radiologists issue preliminary reports for off-hours imaging studies, which are overread by attending radiologists the next day using structured discrepancy templates. In this study, we examined the impact on patient management and outcome of studies with major discordance. MATERIALS AND METHODS: For our retrospective observational study, preliminary reports between March and June 2017 that received major discordance were identified through report text search. Electronic medical records were reviewed for patient management change and patient outcome. RESULTS: Of the 199 cases, 52 cases (26%) had management change and 119 cases (60%) did not have management change. In 25 cases (13%), the preliminary report was proven correct on subsequent management. Three cases (2%) were lost to follow-up. In only one case was adverse outcome directly related to the discordant finding. In cases with patient management change, there was higher proportion of perceptual error compared with those without management change (73% versus 59%). In 47 cases (24%), the discordant finding or diagnosis was known to the clinical team, and better history could have avoided the major change. CONCLUSION: Adverse outcome from the discordant imaging finding was low (0.5%). Major change in preliminary report could be reduced with better clinical history. Patient management change was more frequently seen with perceptual errors, placing greater emphasis on strategies to reduce them.

Evaluating the Impact of a Call Triage Assistant on Resident Efficiency, Errors, and Stress.

OBJECTIVE: The aim of this study was to evaluate whether a call triage assistant, who answered telephone calls to the main reading room during the busiest hours of weekend call, would impact resident workflow efficiency, diagnostic errors, and stress level. METHODS: The call triage assistant answered all telephone calls to the main reading room from 12 pm to 7 pm on 6 weekend days over a 3-month period. We compared report turnaround times and resident discrepancy rates on these days with control days, when the same residents were on call without the assistant. We also surveyed residents to determine whether the assistants relieved anxiety associated with the call shift. RESULTS: We recorded 168 telephone calls over the study period. We found the majority of telephone calls could be handled by the assistant without disturbing the on-call resident, resulting in a 71% reduction in interruptions. The mean turnaround time for studies read on the days the assistant was on duty was 44.3 min, compared with 75.2 min on the control days (P < .01). Resident major discrepancy rates (0.4% on the intervention days compared to 0.2% on the control days) were similar (P = .58), as were minor discrepancy rates (7.5% on the intervention days compared with 6.7% on the control days; P = .61). Residents reported fewer distractions, improved workflow efficiency, and decreased call-related stress when the assistant was on duty. CONCLUSIONS: A call triage assistant effectively improved workflow efficiency and reduced resident stress on call. Resident error rates were unaffected by the presence of the assistant.

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

OBJECTIVES: Our 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 METHODS: First-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. RESULTS: Students' 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. CONCLUSIONS: Resident-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.

Teaching Radiology Trainees From the Perspective of a Millennial.

The millennial generation consists of today's medical students, radiology residents, fellows, and junior staff. Millennials' comfort with immersive technology, high expectations for success, and desire for constant feedback differentiate them from previous generations. Drawing from an author's experiences through radiology residency and fellowship as a millennial, from published literature, and from the mentorship of a long-time radiology educator, this article explores educational strategies that embrace these characteristics to engage today's youngest generation both in and out of the reading room.

The High-Performing Radiology Residency: A Case Study.

The primary goal of any radiology residency program is to train clinically competent radiologists. However, some radiology programs go above and beyond basic ACGME requirements and produce highly productive radiologists who contribute to the field in research, education and technology. At the core of such residencies are the people who comprise it, including self-motivated, personable residents and faculty who can facilitate excellence from their trainees. Indeed, radiology residencies which create unique programs in response to evolving resident interests can help foster resident-driven research, advocacy, technological innovation and early leadership. These unique programs, when interwoven with a strong educational foundation driven by evidence-based learning techniques and informatics-driven evaluation programs, function to produce highly competent clinicians who become leaders in the field.

Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation.

BACKGROUND: Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present. OBJECTIVE: To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation. METHODS: A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence. RESULTS: About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20-45 years old) were 6.28 times more likely than those ≥ 66 years old (P = .01) and nonwhite participants were 2.7 times more likely than white participants (P = .049) to want family presence. CONCLUSION: Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present.

Attending Radiologist Variability and Its Effect on Radiology Resident Discrepancy Rates.

RATIONALE AND OBJECTIVES: Discrepancy rates for interpretations produced in a call situation are one metric to evaluate residents during training. Current benchmarks, reported in previous studies, do not consider the effects of practice pattern variability among attending radiologists. This study aims to investigate the impact of attending variability on resident discrepancy rates to determine if the current benchmarks are an accurate measure of resident performance and, if necessary, update discrepancy benchmarks to accurately identify residents performing below expectations. MATERIALS AND METHODS: All chest radiographs, musculoskeletal (MSK) radiographs, chest computed tomographies (CTs), abdomen and pelvis CTs, and head CTs interpreted by postgraduate year-3 residents in a call situation over 5 years were reviewed for the presence of a significant discrepancy and composite results compared to prior findings. Simulations of the expected discrepancy distribution for an "average resident" were then performed using Gibbs sampling, and this distribution was compared to the actual resident distribution. RESULTS: A strong inverse correlation between resident volume and discrepancy rates was found. There was wide variability among attendings in both overread volume and propensity to issue a discrepancy, although there was no significant correlation. Simulations show that previous benchmarks match well for chest radiographs, abdomen and pelvis CTs, and head CTs but not for MSK radiographs and chest CTs. The simulations also demonstrate a large effect of attending practice patterns on resident discrepancy rates. CONCLUSIONS: The large variability in attending practice patterns suggests direct comparison of residents using discrepancy rates is unlikely to reflect true performance. Current benchmarks for chest radiographs, abdomen and pelvis CTs, and head CTs are appropriate and correctly flag residents whose performance may benefit from additional attention, whereas those for MSK radiographs and chest CTs are likely too strict.

Why Isn't There More High-fidelity Simulation Training in Diagnostic Radiology? Results of a Survey of Academic Radiologists.

RATIONALE AND OBJECTIVES: Despite its increasing use in training other medical specialties, high-fidelity simulation to prepare diagnostic radiology residents for call remains an underused educational resource. To attempt to characterize the barriers toward adoption of this technology, we conducted a survey of academic radiologists and radiology trainees. MATERIALS AND METHODS: An Institutional Review Board-approved survey was distributed to the Association of University Radiologists members via e-mail. Survey results were collected electronically, tabulated, and analyzed. RESULTS: A total of 68 survey responses representing 51 programs were received from program directors, department chairs, chief residents, and program administrators. The most common form of educational activity for resident call preparation was lectures. Faculty supervised "baby call" was also widely reported. Actual simulated call environments were quite rare with only three programs reporting this type of educational activity. Barriers to the use of simulation include lack of faculty time, lack of faculty expertise, and lack of perceived need. CONCLUSIONS: High-fidelity simulation can be used to mimic the high-stress, high-stakes independent call environment that the typical radiology resident encounters during the second year of training, and can provide objective data for program directors to assess the Accreditation Council of Graduate Medical Education milestones. We predict that this technology will begin to supplement traditional diagnostic radiology teaching methods and to improve patient care and safety in the next decade.

Multinucleate host cells induced by Vittaforma corneae (Microsporidia).

The microsporidium Vittaforma corneae develops within the target cell cytoplasm. In the present study, green monkey kidney (E6) cells infected at 30 degrees C, 35 degrees C or 37 degrees C with V. corneae developed enlarged multinucleate structures of up to 200 microm in any horizontal dimension made up either of a single cell or of multiple fused cells. A number of epithelial cell types (SW-480, HT-29, Caco-2 and HCT-8) were infected with V. corneae but did not induce the same highly organized structures, suggesting that for the structure to develop, the host cell must be capable of continued mitosis, and not be differentiated or be detaching from the surface matrix. Live cell imaging of infected E6 cells revealed large, multinucleate infected cells characterized by a central focus from which radiated parasite stages and host cell mitochondria. Immunocytochemistry identifying gamma and alpha tubulin suggested that a single centrally-located microtubule organizing centre governed the distribution of parasite stages and host cell organelles, with mitochondria and parasites being eventually transported towards the periphery of the structure. Whole cell patch clamp analysis of infected cells indicated an average five-fold increase in total membrane capacitance, consistent with an enlarged single cell. Scanning electron microscopy revealed cell-like protrusions around the periphery of the structure with the intervening space being made up of parasites and cell debris. Clearly in the case of V. corneae-infected E6 cells the parasite-host cell relationship involves subverting the host cell cytoskeleton and cell volume control, providing the parasite with the same protected niche as does a xenoma.

Milestones on a Shoestring: A Cost-Effective, Semi-automated Implementation of the New ACGME Requirements for Radiology.

RATIONALE AND OBJECTIVES: The advent of the ACGME's Next Accreditation System represents a significant new challenge for residencies and fellowships, owing to its requirements for more complex and detailed information. MATERIAL AND METHODS: We developed a system of online assessment tools to provide comprehensive coverage of the twelve ACGME Milestones and digitized them using freely available cloud-based productivity tools. These tools include a combination of point-of-care procedural assessments, electronic quizzes, online modules, and other data entry forms. Using free statistical analytic tools, we also developed an automated system for management, processing, and data reporting. RESULTS: After one year of use, our Milestones project has resulted in the submission of over 20,000 individual data points. The use of automated statistical methods to generate resident-specific profiles has allowed for dynamic reports of individual residents' progress. These profiles both summarize data and also allow program directors access to more granular information as needed. CONCLUSION: Informatics-driven strategies for data assessment and processing represent feasible solutions to Milestones assessment and analysis, reducing the potential administrative burden for program directors, residents, and staff.

Increased error rates in preliminary reports issued by radiology residents working more than 10 consecutive hours overnight.

RATIONALE AND OBJECTIVES: To determine if the rate of major discrepancies between resident preliminary reports and faculty final reports increases during the final hours of consecutive 12-hour overnight call shifts. MATERIALS AND METHODS: Institutional review board exemption status was obtained for this study. All overnight radiology reports interpreted by residents on-call between January 2010 and June 2010 were reviewed by board-certified faculty and categorized as major discrepancies if they contained a change in interpretation with the potential to impact patient management or outcome. Initial determination of a major discrepancy was at the discretion of individual faculty radiologists based on this general definition. Studies categorized as major discrepancies were secondarily reviewed by the residency program director (M.H.S.) to ensure consistent application of the major discrepancy designation. Multiple variables associated with each report were collected and analyzed, including the time of preliminary interpretation, time into shift study was interpreted, volume of studies interpreted during each shift, day of the week, patient location (inpatient or emergency department), block of shift (2-hour blocks for 12-hour shifts), imaging modality, patient age and gender, resident identification, and faculty identification. Univariate risk factor analysis was performed to determine the optimal data format of each variable (ie, continuous versus categorical). A multivariate logistic regression model was then constructed to account for confounding between variables and identify independent risk factors for major discrepancies. RESULTS: We analyzed 8062 preliminary resident reports with 79 major discrepancies (1.0%). There was a statistically significant increase in major discrepancy rate during the final 2 hours of consecutive 12-hour call shifts. Multivariate analysis confirmed that interpretation during the last 2 hours of 12-hour call shifts (odds ratio (OR) 1.94, 95% confidence interval (CI) 1.18-3.21), cross-sectional imaging modality (OR 5.38, 95% CI 3.22-8.98), and inpatient location (OR 1.81, 95% CI 1.02-3.20) were independent risk factors for major discrepancy. CONCLUSIONS: In a single academic medical center, major discrepancies in resident preliminary reports increased significantly during the final 2 hours of consecutive 12-hour overnight call shifts. This finding could be related to either fatigue or circadian desynchronization. Discrimination of these two potential etiologies requires additional investigation as major discrepancies in resident reports have the potential to negatively impact patient care/outcome. Cross-sectional imaging modalities including computed tomography and ultrasound (versus conventional radiography), as well as inpatient location (versus Emergency Department location), were also associated with significantly higher major discrepancy rates.