Teaching the Future Radiologist: TED-Inspired Radiology Didactics.

TED (acronym for technology, entertainment and design) conferences are an astonishingly successful modern-day platform for "ideas worth spreading". These continue to engage, enlighten and entertain an ever-expanding audience base. TED speakers highlight simple yet relevant ideas, often challenging entrenched perspectives and proposing hitherto unexplored solutions. In this perspective, the authors propose modeling some aspects of Radiology didactics along certain fundamental principles of TED and outline techniques to accomplish this. We overview how this shift can engage diverse learners and enhance retention of key information. We include evidence on such pedagogical techniques boosting learners' working memory and providing strategies for creative problem solving. Finally, we caution educators against criticisms of the TED format, including prioritizing style over content, "dumbing down" information to make it fit a prescribed format and sometimes offering insufficient scientific rigor.

An Abscopal Effect on Lung Metastases in Canine Mammary Cancer Patients Induced by Neoadjuvant Intratumoral Immunotherapy with Cowpea Mosaic Virus Nanoparticles and Anti-Canine PD-1.

Neoadjuvant intratumoral (IT) therapy could amplify the weak responses to checkpoint blockade therapy observed in breast cancer (BC). In this study, we administered neoadjuvant IT anti-canine PD-1 therapy (IT acPD-1) alone or combined with IT cowpea mosaic virus therapy (IT CPMV/acPD-1) to companion dogs diagnosed with canine mammary cancer (CMC), a spontaneous tumor resembling human BC. CMC patients treated weekly with acPD-1 (n = 3) or CPMV/acPD-1 (n = 3) for four weeks or with CPMV/acPD-1 (n = 3 patients not candidates for surgery) for up to 11 weeks did not experience immune-related adverse events. We found that acPD-1 and CPMV/acPD-1 injections resulted in tumor control and a reduction in injected tumors in all patients and in noninjected tumors located in the ipsilateral and contralateral mammary chains of treated dogs. In two metastatic CMC patients, CPMV/acPD-1 treatments resulted in the control and reduction of established lung metastases. CPMV/acPD-1 treatments were associated with altered gene expression related to TLR1-4 signaling and complement pathways. These novel therapies could be effective for CMC patients. Owing to the extensive similarities between CMC and human BC, IT CPMV combined with approved anti-PD-1 therapies could be a novel and effective immunotherapy to treat local BC and suppress metastatic BC.

Practical Tips and a Template for Developing Your Curriculum Vitae.

The Alliance of Leaders in Academic Affairs in Radiology (ALAAR) advocates for a Universal Curriculum Vitae for all medical institutions and to that end, we have developed a template that can be downloaded on the AUR website (ALAAR CV template) that includes all of the elements required by many academic institutions. Members of ALAAR represent multiple academic institutions and have spent many hours reviewing and providing input on radiologists' curricula vitae. The purpose of this review is to help academic radiologists accurately maintain and optimize their CVs with minimal effort and to clarify common questions that arise at many different institutions in the process of constructing a CV.

Implementation of a Departmental Resident Web-Based Database.

RATIONALE AND OBJECTIVES: The Accreditation Council for Graduate Medical Education requires the gathering, monitoring, analysis, and reporting of a large number of resident performance parameters. To provide faster and more efficient documentation and tracking, we developed an online database. MATERIAL AND METHODS: We used a commercial, customizable and affordable web-based relational database software to develop a multiplatform, flexible database that can track a myriad of resident data and is easy for residents, faculty, and administrative personnel to enter and retrieve specific data. The database can quickly build report pages/pivot tables according to user specifications/needs. RESULTS: Since the implementation in January 2015-April 2020, over 34,355 data entries have been made. Around 82% of our current residents agree or strongly agree that the database is a useful addition to our program, with 53% of resident respondents agreeing or strongly agreeing that the database is intuitive, easy to navigate, and allows for quick data entry. A total of 61% of the faculty respondents agreed or strongly agreed that the database is a useful addition to the residency program. Pre Clinical Competency Committee (CCC) meeting preparation time by the Program Coordinator has been reduced by about 90%, and by CCC faculty by at least 50%. Annual Accreditation Data System (ADS) web reporting has become faster and more streamlined. CONCLUSION: The database has markedly facilitated and improved efficiency of Milestones and ADS reporting as well as preparation and review of this data at CCC and Program Evaluation Committee meetings. Residents can monitor their own performance throughout residency. The database structure can be exported to other institutions.

Great Question! The Art and Science of Crafting High-Quality Multiple-Choice Questions.

Assessment of medical knowledge is essential to determine the progress of an adult learner. Well-crafted multiple-choice questions are one proven method of testing a learner's understanding of a specific topic. The authors provide readers with rules that must be followed to create high-quality multiple-choice questions. Common question writing mistakes are also addressed to assist readers in improving their item-writing skills.

Online Hide and Seek: Allopathic US Medical Schools' Radiology Education Virtual Presence.

RATIONALE AND OBJECTIVES: To highlight radiology's merits and boost appeal to medical students in the digital era, it is increasingly important for radiology departments to be readily accessible to medical students. We report the results of a multivariate analysis of the virtual presence of radiology medical student education of 152 allopathic United States (US) medical schools, the first report of its kind to the authors' knowledge. We detail eight elements to include when optimizing a radiology medical student education website. METHODS: In August 2020, the Department of Radiology websites at 152 allopathic US medical schools were assessed for the presence of a medical student radiology education website and accessibility of collated information about preclinical and clinical course offerings, radiology interest groups, and outreach initiatives in the form of student radiology mentorship, shadowing, and research opportunities. RESULTS: 65.1% (99/152) of allopathic US medical schools' radiology departments have a dedicated medical student radiology education website, one of which was excluded from further review due to password protected content. 58.2% (57/98) of departmental websites include information about preclinical radiology coursework and 90.8% (89/98) of departments provide information about clinical courses. Details about interest groups were found on 26.5% (26/98) of departmental websites. Information about mentorship and shadowing was identified on less than half of departmental websites. 51% (50/98) of Department of Radiology websites provide information about research opportunities for students. CONCLUSIONS: This study demonstrates that the majority of allopathic US medical schools' radiology departments lack full information of relevance to medical students. To engage today's and tomorrow's medical learners digitally, there is opportunity and need to improve the online availability of information about preclinical and clinical radiology courses, student interest groups, shadowing opportunities, student mentorship, and student research. We detail eight elements to include when optimizing a radiology medical student education website. In most instances, this can be accomplished by revising an existing radiology department website in a manner that engages, educates, and recruits medical students. As a specialty, radiology must expand our digital footprint to reach tomorrow's colleagues and leaders.

The ADVICER Template for Faculty Reviewer Letters for Promotion and Appointment.

RATIONALE AND OBJECTIVES: Promotion is an important milestone in the career of academic radiologists. Appointments, Promotion and Tenure (APT) committees require multiple letters of support from both internal and external referees. Traditional narrative letters are highly subjective, have high inter-reader variability, are time-intensive, and vulnerable to gender and other biases. The Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER) recognized the need for a standardized template to assist academic faculty, letter writers, and APT committees. MATERIALS AND METHODS: An ADVICER ad hoc committee of six educators with experience serving as external referees was convened to create a standardized template. Committee members performed a search of the relevant literature and internet sites, spoke with stakeholders such as APT chairs, and ultimately developed a template for faculty reviewer letters using the common clinician-educator pathway as a focal point. RESULTS: An open source, modifiable, standardized, template was produced. The template has been made available to ADVICER members and is available on the Association of University Radiologists (AUR) website at: https://www.aur.org/resources/Template-for-Faculty-Reviewer-Letters-for-Promotion-and-Appointment CONCLUSION: This external referee template has the potential to reduce subjectivity, eliminate bias, and provide a flexible, modifiable, comprehensive faculty review letter template which will be useful for academic faculty, letter writers, and promotions committees.

AI-RADS: An Artificial Intelligence Curriculum for Residents.

RATIONALE AND OBJECTIVES: Artificial intelligence (AI) has rapidly emerged as a field poised to affect nearly every aspect of medicine, especially radiology. A PubMed search for the terms "artificial intelligence radiology" demonstrates an exponential increase in publications on this topic in recent years. Despite these impending changes, medical education designed for future radiologists have only recently begun. We present our institution's efforts to address this problem as a model for a successful introductory curriculum into artificial intelligence in radiology titled AI-RADS. MATERIALS AND METHODS: The course was based on a sequence of foundational algorithms in AI; these algorithms were presented as logical extensions of each other and were introduced as familiar examples (spam filters, movie recommendations, etc.). Since most trainees enter residency without computational backgrounds, secondary lessons, such as pixel mathematics, were integrated in this progression. Didactic sessions were reinforced with a concurrent journal club highlighting the algorithm discussed in the previous lecture. To circumvent often intimidating technical descriptions, study guides for these papers were produced. Questionnaires were administered before and after each lecture to assess confidence in the material. Surveys were also submitted at each journal club assessing learner preparedness and appropriateness of the article. RESULTS: The course received a 9.8/10 rating from residents for overall satisfaction. With the exception of the final lecture, there were significant increases in learner confidence in reading journal articles on AI after each lecture. Residents demonstrated significant increases in perceived understanding of foundational concepts in artificial intelligence across all mastery questions for every lecture. CONCLUSION: The success of our institution's pilot AI-RADS course demonstrates a workable model of including AI in resident education.

Brave New World: Challenges and Opportunities in the COVID-19 Virtual Interview Season.

The COVID-19 pandemic has forced the transition of the traditional residency interview to a virtual format. This new interview format creates additional challenges and opportunities for both programs and applicants. The specific challenges of the virtual interview format are described, as well as means to mitigate those challenges. In addition, opportunities to improve residency selection from the program end are described.

The Early Influence and Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Resident Education and Adaptations.

The novel coronavirus disease 2019 (COVID-19) has had a major impact on the education of trainees in the radiology environment. The precipitous drop in patient volumes and sequestering of faculty and trainees to maintain social distancing affects experiential learning. The shift of nearly all teaching settings to a virtual environment has been challenging but may also allow more interaction during teaching sessions than traditional readout sessions or didactic lectures. Faculty development is key in ensuring competence and confidence in this new environment. Recruitment of trainees using a virtual platform will require communication of opportunities as well as the culture of the department and institution as well as the community. Delay of the board examinations has caused angst as well as disruption of the timing of clinical rotations but may ultimately result in a shift of how the examinations are administered. The exceptional disruption of the COVID-19 pandemic allows us to reconsider how the educational aspects of imaging can emerge as improved in the years to come.

Role of breast MRI in the preoperative evaluation of patients with newly diagnosed breast cancer.

OBJECTIVE: The purpose of our study was to evaluate in a non-investigational setting the effect of preoperative breast MRI on the diagnosis of unsuspected additional malignant tumors and on surgical management choices. SUBJECTS AND METHODS: One hundred ninety-nine patients with a new diagnosis of breast cancer who underwent preoperative bilateral breast MRI were enrolled. Data included additional imaging and biopsies performed, final surgical management, and pathologic correlation. To reduce bias due to patient preference and variable surgical approaches, ipsilateral malignant lesions found on breast MR images were retrospectively reviewed by a surgeon blinded to final surgical treatment. RESULTS: MRI detected additional suspicious previously unsuspected lesions in 74 patients (37%). Fifty-four of these lesions, in 38 patients (19%), were identified as malignant, of which 41 (76%) were invasive. Retrospective review of the MRI-identified ipsilateral malignant lesions resulted in hypothetical recommendations that would have altered the surgical treatment of 26 of the patients (13%), principally as mastectomy or wider excision. CONCLUSION: For patients with a new diagnosis of breast cancer, breast MRI in a mid-sized regional hospital depicts unsuspected malignant lesions in both the ipsilateral and contralateral breasts in proportions consistent with the results of earlier studies at larger institutions. Whether clinical outcome is improved by changes in surgical management consequent to MRI detection of unsuspected malignant lesions remains unproven.

Screening for recurrences in patients treated with breast-conserving surgery: is there a role for MRI?

BACKGROUND: Although it has been shown that magnetic resonance imaging (MRI) is more sensitive than mammography in the detection of breast cancer in high-risk populations, there is little data on the use of MRI as a screening tool to detect recurrence after breast-conserving surgery. Our objective was to determine the potential role of MRI in the screening of breast cancer patients treated with breast-conserving surgery. METHODS: Retrospective chart review of all patients undergoing margin-negative lumpectomy and adjuvant radiation therapy for infiltrating breast carcinoma between 1(st) January 1993 and 1(st) January 2004. Patients were followed for recurrence in the ipsilateral or contralateral breast by physical exam and mammography. RESULTS: Four hundred and seventy-six primary tumor excisions were performed. Patients were followed for a median of 5.4 years. Ipsilateral breast recurrences developed in eight patients (1.7%) with a mean diameter of 1.6 cm. All of these women are alive and free of metastases. Contralateral cancers developed in 11 patients (2.3%) with a mean diameter of 1.5 cm. Ten of these 11 women are alive and free of disease. CONCLUSIONS: In a contemporary patient population the risk of local recurrence after lumpectomy and radiation therapy is very low. If screening MRI had been a part of annual follow-up, a total of 2570 MRIs would have been performed. Given the small tumor size at detection and the excellent survival of those who recurred, annual screening MRI would have incurred significant cost and would have been unlikely to improve overall survival.

Assessing Resident Performance in Screening Mammography: Development of a Quantitative Algorithm.

RATIONALE AND OBJECTIVES: This study aims to provide objective performance data and feedback, including examination volumes, recall rates, and concordance with faculty interpretations, for residents performing independent interpretation of screening mammography examinations. METHOD AND MATERIALS: Residents (r) and faculty (f) interpret screening mammograms separately and identify non-callbacks (NCBs) and callbacks (CBs). Residents review all discordant results. The number of concordant interpretations (fCB-rCB and fNCB-rNCB) and discordant interpretations (fCB-rNCB and fNCB-rCB) are entered into a macro-driven spreadsheet. These macros weigh the data dependent on the perceived clinical impact of the resident's decision. Weighted outcomes are combined with volumes to generate a weighted mammography performance score. Rotation-specific goals are assigned for the weighted score, screening volumes, recall rate relative to faculty, and concordance rates. Residents receive one point for achieving each goal. RESULTS: Between July 2013 and May 2017, 18,747 mammography examinations were reviewed by 31 residents, in 71 resident rotations, over 246 resident weeks. Mean resident recall rate was 9.9% and significantly decreased with resident level (R), R2 = 11.3% vs R3 = 9.4%, R4 = 9.2%. Mean resident-faculty discordance rate was 10% and significantly decreased from R2 = 12% to R4 = 9.6%. Weighted performance scores ranged from 1.1 to 2.0 (mean 1.6, standard deviation 0.17), but did not change with rotation experience. Residents had a mean goal achievement score of 2.6 (standard deviation 0.47). CONCLUSIONS: This method provides residents with easily accessible case-by-case individualized screening outcome data over the longitudinal period of their residency, and provides an objective method of assessing resident screening mammography performance.

The Clinician-Educator Pathway in Radiology: An Analysis of Institutional Promotion Criteria.

PURPOSE: To provide radiology departmental promotional committees and vice chairs of education with a more global perspective on the types of academic activity valued by institutions to aid in their faculty mentoring and standardizing of the Clinician-Educator (ClinEd) pathway. METHODS: Ninety-two research schools were ranked into three tiers. Ranking was correlated with the presence of a ClinEd track. Thirty promotion documents (ten from each tier) were analyzed to identify common criteria. Differences in guidelines between tiers were assessed by the frequency distribution of criteria. RESULTS: Tier 1 had a significantly greater proportion of schools with a ClinEd track than tier 2 (73% versus 44%, p < 0.05). Thirty-nine criteria were identified and organized into four categories teaching (13), scholarship (12), service/clinical excellence (7), and research (7). The top five included meeting presentations, trainee evaluations, leadership in committees, development of teaching methodologies and materials, and publication of book chapters. First and second tier schools were most similar in frequency distribution. CONCLUSIONS: The criteria for the ClinEd promotion track still vary across institutions, though many commonalities exist. A handful of innovative criteria reflect the changing structure of modern health care systems, such as incorporation of online teaching modules and quality improvement efforts. As health care changes, guidelines and incentive structures for faculty should change as well. The information gathered may provide promotion committees with a more global perspective on the types of academic activity valued by modern-day institutions to aid in the national standardization of this pathway and to assist in faculty mentoring.

Video-Based Teaching of Image-Guided Breast Interventions: Stereotactic Core Biopsy Using a Prone Table.

Introduction: The introduction of new technologies and teaching strategies to educate the digital learner creates the potential for a better and more standardized training experience across programs. Thus, we sought to create an instructional video on stereotactic core breast biopsy that simulates best practices and could be readily accessed by training programs to improve and standardize resident education. Methods: At our institution, we use the video and questions as part of a flipped classroom educational activity. Residents are requested to complete the questions at home and watch the video. They then take the posttest questions during the lecture period, at which time the answers are reviewed and there is additional discussion of the procedure. The tests contain both video-related questions and control questions. Results: After viewing the video, there was a 30% mean improvement in the video-related questions compared to a 0% improvement in the control set of questions. Discussion: An instructional video on stereotactic core biopsy was created with associated assessment questions that can be used at any institution for the purposes of improving and standardizing training in breast imaging procedures. This resource can be especially useful for programs where trainees have limited procedure exposure.

Brain Friendly Teaching-Reducing Learner's Cognitive Load.

Many didactic lectures induce a cognitive load in learners out of proportion to the content that they need to learn (or can learn) during that teaching session. This is due in part to the content, and in part to the way it is displayed or presented. By reducing the cognitive load on our audience, we can increase long-term retention of information. This article briefly summarizes some of the science behind cognitive load as it relates to presentations, and identifies simple steps to reduce it, while maximizing learning.

Guidelines for the Scholarly Use of Images.

As academic radiologists, we use a variety of images in our educational "products" regularly-whether they are lectures, websites, papers, digital media, or other resources. As the ability to download images from the Internet has proliferated, the need for us to have a basic understanding of copyright laws and how they might be applied to our products has increased. This article aims to provide answers to the most common questions. Please note that this article is for informational purposes and should not be considered legal advice.

Driving Innovation in Radiology: A Summary of the 2015 Intersociety Committee Summer Conference.

The membership of the Intersociety Committee convened to consider how best to continue to stimulate, nurture, and support innovation in radiologic research and education in the face of ever increasing clinical demands and financial constraints. The topic was chosen in recognition that the growth and success of radiology over the past 50-plus years have been driven by spectacular technological developments in imaging and intervention and that the future relevance of the specialty will hinge on how the specialty continues to evolve. To keep radiology a dynamic and vital component of the health care enterprise will require continued innovation in technology and the requisite education that goes with it.

Medical Student Performance After a Vertically Integrated Radiology Clerkship.

PURPOSE: Proper selection of imaging examinations and basic image interpretation skills are essential for all physicians, yet only approximately 25% of US medical schools require clerkships in radiology. Although there is limited time in most medical school curricula to allow the addition of a required radiology clerkship, the authors developed one that is vertically integrated over a two-year period. This clerkship includes one week of contact with radiologists distributed over the M2 and M3 years, podcasts, online modules, required readings, and presentations. A standard national examination is administered at the end of the clerkship period. This clerkship was designed to address the educational needs of students while occupying minimal time in the curriculum. The purpose of this study was to determine if students completing this clerkship perform as well on a national radiology examination as students from other medical schools, regardless of their curricula. METHODS: At the end of the M3 year, these students take a computer-based radiology examination developed by the Alliance of Medical Student Educators in Radiology and used by students at multiple medical schools nationally. The mean and median scores of these students were compared with those of students at these other institutions. RESULTS: The mean and median scores of the students were 74% and 74% (standard deviation, 7.5%) compared with 74% and 50% (standard deviation, 8.4%) at other institutions. CONCLUSIONS: Students completing this vertically integrated radiology clerkship had test scores comparable with those of students at other medical schools.