Assessing the debt and current state of financial literacy in a cohort of diagnostic & interventional radiology residents.

RATIONALE AND OBJECTIVES: The purpose of this study is to assess diagnostic and interventional radiology resident physicians' knowledge of core facets of financial literacy: loans, real estate, investments and retirement, and insurance, with the goal of determining the need for formal financial literacy education within radiology residency programs. METHODS: From May 2021 to March 2022, surveys were sent to 196 diagnostic and 90 interventional radiology residency programs. Residents were asked 10 knowledge multiple choice questions to assess areas of financial literacy. Custom R programming was used to evaluate responses. RESULTS: A total of 149 diagnostic radiology residents and 49 interventional radiology residents responded to portions of the survey, for a total of 198 respondents. Of the cohort with demographic data collected, 84 out of 141 residents (60 %) had over $100,000 of debt following medical school graduation, with 115 out of 146 DR residents (79 %) and 41 out of 47 (87 %) IR residents reporting no coursework in finance. CONCLUSIONS: Many radiology resident physicians have a significant debt burden, no official financial education, and clear knowledge gaps in areas of financial literacy. A structured financial education curriculum could better prepare residents for the financial realities of post-residency life.

Rules for Interventional Radiology.

During the hands-on teaching of Interventional Radiology (IR) to Residents and Fellows, certain learning tips or guiding statements are often repeated. Over the past two decades, these tips have evolved into the "Rules for Interventional Radiology." Relying on humour and the technical and foundational principles of our subspeciality, it is hoped that these Rules for IR provide helpful guidance to learners and practising Interventionalists in their daily work.

Demographic Trends in Female Interventional Radiology Trainees With the Advent of the Integrated Interventional Radiology Residency.

OBJECTIVE: Examine changes in gender representation in the interventional radiology (IR) training pool since the advent of the integrated IR residency in 2015 to 2020. METHODS: Electronic Residency Application Service and ACGME Data Resource Book records from 2015 to 2020 were reviewed for integrated IR residency and vascular and interventional radiology (VIR) fellowship applicant data and active IR resident and VIR fellow data, respectively. The Society of Interventional Radiology (SIR) 2018 registry data were reviewed for SIR membership data. Two-tailed Fisher's exact tests and χ2 analyses were used to compare trainees between application cycles. RESULTS: In the 2017 application cycle, 23% (247 of 1,062) of integrated IR residency applicants were female, with similar interest in the 2018, 2019, and 2020 cycles (χ2[3, n = 2,863] = 5.1, P = .17). In comparison, female VIR fellowship applicants were 12% from 2017 to 2020. Female integrated IR residents represented 13% to 18% of all integrated IR residents in the 2016 to 2020 academic years compared with the period before the integrated IR residency when female IR trainees represented 8% (23 of 275) of all IR trainees in 2015 to 2016 (P = .0002). Although in 2018, the total active SIR female membership was 9% (319 of 3,622), the female resident membership was 17% (131 of 793), and the female medical student membership was 25% (389 of 1,573). DISCUSSION: With the advent of the integrated IR residency, there is an increasing female constituency, at the medical student, IR applicant, and IR resident levels, with more than a doubling of female IR trainees, portending a continued reduction in the IR gender disparity in the future.

Creating Low-Cost Phantoms for Needle Manipulation Training in Interventional Radiology Procedures.

Image-guided procedures play a critical role in the clinical practice of radiologists. Training radiology residents in these procedures, with early teaching of basic but fundamental skills, is therefore crucial to develop competence before they become autonomous and start their practice. It has been proposed in the literature that low-fidelity phantoms are appropriate to teach novice trainees. The authors propose a series of phantoms to teach the core skills necessary to perform procedures early in resident training. The phantoms described can be used to train skills necessary for performing US-guided biopsy, US-guided vascular puncture, cone-beam CT drainage, and fluoroscopy-guided lumbar puncture, as well as using the parallax effect to determine relative position at fluoroscopy. Phantoms are a valuable training tool, although it is important to consider the teaching audience when choosing or creating a model. For novices, a range of inexpensive low-fidelity gelatin-based phantoms can be used to train core skills in image-guided procedures. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2021.

Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways.

OBJECTIVE: As 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. METHODS: An 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. RESULTS: Ninety-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. DISCUSSION: A 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.

Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective.

PURPOSE: The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada. METHODS: An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics. RESULTS: Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%). CONCLUSION: The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.

Tanzania IR Initiative: Training the First Generation of Interventional Radiologists.

Despite a population of nearly 60 million, there is currently not a single interventional radiologist in Tanzania. Based on an Interventional Radiology (IR) Readiness Assessment, the key obstacles to establishing IR in Tanzania are the lack of training opportunities and limited availability of disposable equipment. An IR training program was designed and initiated, which relies on US-based volunteer teams of IR physicians, nurses, and technologists to locally train radiology residents, nurses, and technologists. Preliminary results support this strategy for addressing the lack of training opportunities and provide a model for introducing IR to other resource-limited settings.

Bridging the Equity Gap.

OBJECTIVE. This article introduces key concepts of inequity as they apply to interventional radiology, from both the patient and the physician perspectives, to ultimately improve the health care of all patients. CONCLUSION. By directing society's efforts toward addressing health care disparities, our specialty may begin to establish trust and partnerships with populations that are disproportionately affected and those that have been historically exploited and disenfranchised by medicine in the name of innovation. Although we may look to close the equity gap by understanding health care disparities as they pertain to our patient populations, a closer examination of barriers of entry into medicine for underrepresented minorities reveals numerous disparities across race, sexual orientation, and socioeconomic status.

Machine learning methods for automated technical skills assessment with instructional feedback in ultrasound-guided interventions.

OBJECTIVE: Currently, there is a worldwide shift toward competency-based medical education. This necessitates the use of automated skills assessment methods during self-guided interventions training. Making assessment methods that are transparent and configurable will allow assessment to be interpreted into instructional feedback. The purpose of this work is to develop and validate skills assessment methods in ultrasound-guided interventions that are transparent and configurable. METHODS: We implemented a method based upon decision trees and a method based upon fuzzy inference systems for technical skills assessment. Subsequently, we validated these methods for their ability to predict scores of operators on a 25-point global rating scale in ultrasound-guided needle insertions and their ability to provide useful feedback for training. RESULTS: Decision tree and fuzzy rule-based assessment performed comparably to state-of-the-art assessment methods. They produced median errors (on a 25-point scale) of 1.7 and 1.8 for in-plane insertions and 1.5 and 3.0 for out-of-plane insertions, respectively. In addition, these methods provided feedback that was useful for trainee learning. Decision tree assessment produced feedback with median usefulness 7 out of 7; fuzzy rule-based assessment produced feedback with median usefulness 6 out of 7. CONCLUSION: Transparent and configurable assessment methods are comparable to the state of the art and, in addition, can provide useful feedback. This demonstrates their value in self-guided interventions training curricula.

The Implications of Acute Clinical Care Responsibilities on the Contemporary Practice of Interventional Cardiology.

The responsibilities of the interventional cardiologist (IC) have evolved in contemporary practice to include substantial acute care clinical duties outside of the cardiac catheterization laboratory. In particular, the IC has assumed a central role in the global management of myocardial infarction and other acute coronary syndromes in the intensive care unit and beyond. These duties have expanded to include many nonprocedural tasks. The Interventional Section Leadership Council (ISLC) of the American College of Cardiology (ACC) therefore recommends: 1) these implications should be directly considered in the ACC's future planning and policy statements concerning manpower, competence, education, and reimbursement; 2) the development of an acute care cardiology subspecialty should be undertaken; 3) steps should be taken to adjust the number of ICs primarily on the basis of optimizing procedural volume and quality; and 4) the annual number of coronary interventions performed should not solely define competence in the future, but should include the performance of acute cardiology responsibilities.

Untapped Resources: Attaining Equitable Representation for Women in IR.

PURPOSE: To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators. MATERIALS AND METHODS: Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012-2017) were statistically compared to that of recurring male faculty. RESULTS: From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P = .722; total publications P = .689; and authorship P = .662). CONCLUSIONS: This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record.

Tools for Simulation; Low Budget and No Budget.

Interventional Radiology (IR) incorporates a unique set of technical skills such as ultrasound-guided needle placement, inferior vena cava filter placement, and wire/catheter exchange, which are not easily attained in other aspects of medical training. Simple, low cost models can allow medical students and residents to attain these skills in a low risk setting. These simulated tasks will ultimately combine to improve preparedness of trainees during patient procedures allowing them to advance more quickly through the training paradigm without patient risk. Many commercially available devices may be cost prohibitive, so low cost solutions are presented.

Neurointerventional Radiology for the Aspiring Radiology Resident: Current State of the Field and Future Directions.

OBJECTIVE: The purposes of this study were to document recent trends in stroke intervention at a tertiary-care facility with a comprehensive stroke center and to analyze current procedure volumes and the employment of specialty providers in neurointerventional radiology (NIR). MATERIALS AND METHODS: Institutional trends in the volume of mechanical thrombectomy were analyzed on the basis of the number of patients who underwent mechanical thrombectomy from 2013 to 2017. To evaluate the current status of mechanical thrombectomy volumes in the United States, the number of patients in the Medicare fee-for-service database who underwent mechanical thrombectomy in 2016 was assessed. The specialty backgrounds of the various providers who performed mechanical thrombectomy were analyzed. Procedure volumes for intracranial stenting, embolization, and vertebral augmentation procedures were assessed. RESULTS: From 2013 to 2017, the total numbers of mechanical thrombectomy procedures for acute ischemic stroke were 19 in 2013 and 111 in 2017. The total volume of mechanical thrombectomy procedures in the Medicare fee-for-service population in 2016 was 7479. For intracranial endovascular procedures, 20,850 were performed in the U.S. Medicare population in 2015 and 22,511 in 2016. Radiologists performed 45% of procedures in 2016; neurosurgeons, 41%; and neurologists, 11%. When the total numbers of percutaneous brain and spine procedures were combined, radiologists performed 41%; neurosurgeons, 23%; and neurologists, 3%. In 2016, there were a total of 220 active NIR staff at the NIR programs with rotating residents or fellows. In these programs, 49% of staff members were neuroradiologists, 41% were neurosurgeons, and 10% were neurologists. Of the 72 NIR departments with confirmed rotating fellows or residents, 14 had only neuroradiologists on staff, six had only neurosurgeons, and one had only neurologists. CONCLUSION: Increasing radiology resident interest and participation in NIR should ensure a steady influx of radiologists into the field, continuing the strong tradition of radiology participation, leadership, and innovation in NIR.

Evaluating Factors and Resources Affecting Ranking of Diagnostic Radiology Residency Programs by Medical Students in 2016-2017.

RATIONALE AND OBJECTIVES: Recent changes in radiology curriculum and access to residency program information, including the introduction of various online resources and the Interventional Radiology integrated pathway, may influence the rank list order of medical student applicants. The purpose of this study is to assess factors that affect the rank lists of medical students applying to our radiology residency program in the 2016-2017 academic year. MATERIALS AND METHODS: After IRB approval, an anonymous online 19 question survey was emailed to 622 applicants to our diagnostic radiology and/or interventional radiology integrated pathway. Applicants ranked 35 unique factors that may influence their residency rank list order from 1 (not important at all) to 5 (very important), listed their top five 'very important' factors, and ranked various sources of information used to learn about residency programs. General applicant demographic questions were also included. RESULTS: Response rate was 18.8% (117/622). The 5 most important factors affecting applicant ranking of programs are perceived happiness of the residents and faculty (4.69), fellowship and job placement of recent graduates (4.34), interactions with programs' current residents (4.33), stability of the department and program (4.29), and geographic location of the program (4.27). The top 5 resources for learning about residency programs were interactions with current residents at the program (4.47), program director (3.87), and interviewing faculty (3.87). Individual program websites were ranked more highly than internet message boards and forums as an information source. CONCLUSION: Medical students consider a large number of factors and resources in determining their rank lists, with factors encountered during the interview day playing a significant role in shaping the applicants' view of a residency program.

Interventional Radiology in Canada: Current Challenges and Future Directions.

OBJECTIVE: We aim to define the practice of interventional radiology (IR) in Canada, barriers that have been faced by interventional radiologists, and ways in which the Canadian Interventional Radiology Association (CIRA) have attempted to address these issues. CONCLUSION: IR has faced significant challenges in the Canadian setting. Recognizing the need to address these challenges, leaders in the field of IR in Canada founded the CIRA to serve as our national voice and lobby group.