Imposter phenomenon in radiology: incidence, intervention, and impact on wellness.

PURPOSE: Imposter phenomenon refers to feelings of inadequacy due to inability to internalize evident success. While high achievers such as physicians have been known to exhibit imposter phenomenon, there is limited literature specific to radiologists. Our purpose was to (1) investigate imposter phenomenon in radiologists and assess correlation with burnout, and (2) pilot an intervention aimed at addressing imposter phenomenon through improvisational theater techniques. METHODS: Part 1 - Clinical radiology faculty at a single large academic medical center completed an anonymous survey with questions related to demographics, burnout (derived from the validated Mini-Z assessment tool), and imposter phenomenon. Part 2 - A one-hour interactive workshop on imposter phenomenon was organized for the radiology department at the same institution. The workshop included the Clance Imposter Phenomenon Scale (CIPS). A post-workshop survey rating was also performed. RESULTS: Part 1 - Of 30 clinical radiology faculty who participated in the survey, 83% reported feelings of imposter phenomenon during their career. There was significant (p = 0.024) correlation between imposter phenomenon and burnout. Part 2 - Of 21 members of the Department of Radiology who completed the CIPS in the interactive workshop, 71% exhibited frequent or intense symptoms of imposter phenomenon. On the post-workshop survey asking participants to rate the workshop, the mean score was 4.4 and the mode score was 5 on a scale of 1 (poor) to 5 (excellent). CONCLUSION: Imposter phenomenon affects radiologists and is correlated with burnout. Innovative interventions to address imposter phenomenon such as workshops utilizing medical improvisational techniques are well-received.

Choosing the Best Treatment Approach for Axial Vein Reflux: Thermal versus Nonthermal Approaches.

Chronic venous insufficiency is a common and treatable medical condition which has a high morbidity if left untreated, progressing to lower extremity edema, skin changes of lipodermatosclerosis, and venous ulceration. Treatment options have significantly expanded over the last several decades, shifting away from the traditional surgical approach to more minimally invasive procedures such as endoluminal venous laser ablation or radiofrequency ablation. Even more recently, several techniques using nonthermal methods to ablate varicose veins have been developed, which offer the advantage of not requiring labor-intensive and painful tumescent anesthesia to protect the surrounding tissues. These techniques include mechanochemical ablation, cyanoacrylate closure, or polidocanol microfoam injection and can be offered to a wider range of patients without the need for sedation while offering similar closure rates and improved postprocedure symptom profile. Furthermore, certain patient characteristics which might preclude or complicate the use of thermal ablation methods might not pose a problem with nonthermal nontumescent methods.

Impact of Prior Unilateral Chest Wall Radiotherapy on Outcomes in Bilateral Breast Reconstruction.

BACKGROUND: The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction. METHODS: A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control. Descriptive and bivariate statistics were computed. Multiple regression statistics were computed to identify adjusted associations between chest wall radiotherapy and complications. RESULTS: Seventy patients were included in the study. The mean follow-up period was 51.8 months (range, 10 to 113 months). Thirty-eight patients underwent implant-based breast reconstruction; 32 patients underwent abdominal autologous flap reconstruction. Previously irradiated breast had a significantly higher rate of overall complications (51 percent versus 27 percent; p < 0.0001), infection (13 percent versus 6 percent; p = 0.026), and major skin necrosis (9 percent versus 3 percent; p = 0.046). After adjusting for age, body mass index, reconstruction method, and medical comorbidities, prior chest wall radiotherapy was a significant risk factor for breast-related complications (OR, 2.98; p < 0.0001), infection (OR, 2.59; p = 0.027), and major skin necrosis (OR, 3.47; p = 0.0266). There were no differences between implant-based and autologous reconstructions with regard to complications (p = 0.76). CONCLUSION: Prior chest wall radiotherapy is associated with a 3-fold increased risk of postoperative complications following immediate breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Regulation of silk material structure by temperature-controlled water vapor annealing.

We present a simple and effective method to obtain refined control of the molecular structure of silk biomaterials through physical temperature-controlled water vapor annealing (TCWVA). The silk materials can be prepared with control of crystallinity, from a low content using conditions at 4 °C (α helix dominated silk I structure), to highest content of ∼60% crystallinity at 100 °C (ß-sheet dominated silk II structure). This new physical approach covers the range of structures previously reported to govern crystallization during the fabrication of silk materials, yet offers a simpler, green chemistry, approach with tight control of reproducibility. The transition kinetics, thermal, mechanical, and biodegradation properties of the silk films prepared at different temperatures were investigated and compared by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), uniaxial tensile studies, and enzymatic degradation studies. The results revealed that this new physical processing method accurately controls structure, in turn providing control of mechanical properties, thermal stability, enzyme degradation rate, and human mesenchymal stem cell interactions. The mechanistic basis for the control is through the temperature-controlled regulation of water vapor to control crystallization. Control of silk structure via TCWVA represents a significant improvement in the fabrication of silk-based biomaterials, where control of structure-property relationships is key to regulating material properties. This new approach to control crystallization also provides an entirely new green approach, avoiding common methods that use organic solvents (methanol, ethanol) or organic acids. The method described here for silk proteins would also be universal for many other structural proteins (and likely other biopolymers), where water controls chain interactions related to material properties.