PI-RADS: Past, present, and future.

Prostate cancer (PCa) is extremely prevalent and is the most common noncutaneous malignancy and second-most common cause of cancer death in men. In the last decade, there has been dramatic growth in the use of multiparametric magnetic resonance imaging (mpMRI) for diagnosis and characterization of PCa. With the recent and marked surge in popularity in prostate imaging and, specifically, mpMRI, there has been an increased focus on structured reporting as a means by which to provide more actionable information to the referring clinician as well as to improve diagnostic performance with this technique. This work focuses on the evolution of the major structured reporting system in prostate mpMRI, Prostate Imaging Reporting And Data System (PI-RADS), from its initial proposal and establishment in 2012 as PI-RADS v. 1 to its most current iteration, PI-RADS v. 2.1. This will highlight the key elements that have changed between the versions as well as provide context and rationale for these changes. In addition, this work explores what future iterations of PI-RADS could look like based on current limitations of the system as well as explore areas for future growth of prostate mpMRI, including use of the system in active surveillance populations and in the posttreatment setting. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;52:33-53.

Implementation of a Surgical Oncology Disparities Curriculum for Preclinical Medical Students.

BACKGROUND: Underinsured and uninsured surgical-oncology patients are at higher risk of perioperative morbidity and mortality. Curricular innovation is needed to train medical students to work with this vulnerable population. We describe the implementation of and early educational outcomes from a student-initiated pilot program aimed at improving medical student insight into health disparities in surgery. MATERIALS/METHODS: First-year medical students participated in a dual didactic and perioperative-liaison experience over a 10-month period. Didactic sessions included surgical-skills training and faculty-led lectures on financial toxicity and management of surgical-oncology patients. Students were partnered with uninsured and Medicaid patients receiving surgical-oncology care and worked with these patients by providing appointment reminders, clarifying perioperative instructions, and accompanying patients to surgery and clinic appointments. Students' interest in surgery and self-reported comfort in 15 Association of American Medical Colleges core competencies were assessed with preparticipation and postparticipation surveys using a 5-point Likert scale. RESULTS: Twenty-four first-year students were paired with 14 surgical-oncology patients during the 2017-2018 academic year. Sixteen students (66.7%) completed both preprogram and postprogram surveys. Five students (31.3%) became "More Interested" in surgery, whereas 11 (68.8%) reported "Similar Interest or No Change." Half of the students (n = 8) felt more prepared for their surgery clerkship after participating. Median self-reported comfort improved in 7/15 competencies including Oral Communication and Ethical Responsibility. All students reported being "Somewhat" or "Extremely Satisfied" with the program. CONCLUSIONS: We demonstrate that an innovative program to expose preclinical medical students to challenges faced by financially and socially vulnerable surgical-oncology patients is feasible and may increase students' clinical preparedness and interest in surgery.