Investigating Canadian Radiology Residents' Personal Financial Literacy: A Nation-Wide Assessment.

Purpose: Canadian resident physicians carry large debt to finance their education, which impacts their wellness and their future decision making. The objective of this observational study is to assess the financial literacy of Canadian radiology residents through testing their financial knowledge and examining their current financial status. Methods: A survey was designed to assess the financial literacy and current financial status of radiology residents, which was distributed to Canadian radiology residents via Google Forms. Descriptive analyses on preliminary data and the association between level of training and financial quiz scores were obtained. Results: 104 valid responses from 16 universities were received. The majority (53%) of residents indicated that their debt was greater than $150 000. Residents on average scored 71% on the financial quiz and the scores were not associated with training level (P = .71). The majority (89%) of residents indicated a strong interest in a formal financial literacy curriculum, with 80% preferring a physician-led curriculum. Conclusion: Overall, residents face a high debt burden. Current resident physicians value a formal financial literacy curriculum as a part of their residency program despite existing financial knowledge. Most importantly, residents feel that a curriculum created with involvement of other physicians would be optimal.

Trainee perceptions of resident duty hour restrictions: a qualitative study of online discussion forums.

OBJECTIVE: Resident duty hour (RDH) restrictions in postgraduate medical education is a controversial yet important topic for study. There is limited literature on authentic trainee perceptions surrounding RDH restrictions to inform evaluation and future planning. Online forums are a widely accessible, yet underused resource, for insight into trainee perceptions. Our objective was to qualitatively assess trainee perceptions of RDH restrictions on online discussion forums. SETTING: Online discussion forums; Premed101 (Canadian forum) and Student Doctor Network (SDN) (American forum). PARTICIPANTS: 6630 posts from 161 discussion threads; comprising 429 posts in 14 threads from Premed101 and 6201 posts in 147 threads from SDN. Posters included medical students, residents and attending physicians. DESIGN: Data were analysed inductively and iteratively to create themes and subthemes. Cocoding, consensus-based decision making and an audit trail were used to ensure trustworthiness. RESULTS: Key findings distilled across both forums include: the relationship between hours worked and competence, the inapplicability of blanket RDH restrictions to all specialties and the inter-relationship between fatigue and patient safety. Discussions of RDH restriction compliance and perceived consequence for the reporting of violations were also featured on the American SDN forum. CONCLUSIONS: The findings of this study reveal multiple themes pertinent to the implementation and revision of RDH restrictions. The most prominent theme was the inapplicability of blanket restrictions on duty hours theme due to the diversity of training needs across specialties and the environmental context of training programmes. Other discussions included the inter-relationship of patient safety and resident competence with duty hours. Lastly, concerns regarding the lack of transparency and psychological safety surrounding RDH violations, were discussed.

Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis.

BACKGROUND: Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone. METHODS: MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided. RESULTS: Forty-two studies reporting on 2 606 296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%). CONCLUSIONS: Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.

Risk of bias assessment of test comparisons was uncommon in comparative accuracy systematic reviews: an overview of reviews.

OBJECTIVES: Comparative diagnostic test accuracy systematic reviews (DTA reviews) assess the accuracy of two or more tests and compare their diagnostic performance. We investigated how comparative DTA reviews assessed the risk of bias (RoB) in primary studies that compared multiple index tests. STUDY DESIGN AND SETTING: This is an overview of comparative DTA reviews indexed in MEDLINE from January 1st to December 31st, 2017. Two assessors independently identified DTA reviews including at least two index tests and containing at least one statement in which the accuracy of the index tests was compared. Two assessors independently extracted data on the methods used to assess RoB in studies that directly compared the accuracy of multiple index tests. RESULTS: We included 238 comparative DTA reviews. Only two reviews (0.8%, 95% confidence interval 0.1 to 3.0%) conducted RoB assessment of test comparisons undertaken in primary studies; neither used an RoB tool specifically designed to assess bias in test comparisons. CONCLUSION: Assessment of RoB in test comparisons undertaken in primary studies was uncommon in comparative DTA reviews, possibly due to lack of existing guidance on and awareness of potential sources of bias. Based on our findings, guidance on how to assess and incorporate RoB in comparative DTA reviews is needed.

Publication Bias: Association of Diagnostic Accuracy in Radiology Conference Abstracts with Full-Text Publication.

Background Recent investigations have identified a faster time to publication for imaging studies with higher diagnostic test accuracy (DTA), but it is unknown whether such studies are more likely to be published. A higher probability of full-text publication for studies with higher DTA could have negative consequences on clinical decision making and patient care. Purpose To evaluate the proportion of imaging diagnostic accuracy studies presented as conference abstracts that reach full-text publication and to identify whether there is an association between diagnostic accuracy and full-text publication in peer-reviewed journals within 5 years after abstract submission. Materials and Methods Diagnostic accuracy research abstracts presented at the Radiological Society of North America (RSNA) Annual Meeting in 2011 and 2012 were evaluated between September 1, 2017, and January 11, 2018. Sensitivity and specificity from the abstracts were used to calculate the Youden index (sensitivity + specificity-1); additional abstract characteristics were extracted. To identify full-text publications within 5 years after abstract submission, PubMed and Google Scholar were searched, and authors were contacted. Logistic regression analysis was used to assess for associations between higher diagnostic accuracy and full-text publication. Results A total of 7970 abstracts were evaluated, and 405 were included. Of these, 288 (71%) reached full-text publication within 5 years after abstract submission. Logistic regression analysis accounting for several confounding variables failed to show an association between reported Youden index in the conference abstract and probability of full-text publication (odds ratio, 1.01; 95% confidence interval: 0.99, 1.02; P = .21). Conclusion More than a quarter of abstracts presented at the RSNA Annual Meeting do not reach full-text publication in peer-reviewed journals. The magnitude of reported diagnostic accuracy was not associated with full-text publication, which is consistent with results of diagnostic accuracy studies in other medical specialties. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Fielding in this issue.

Comparative reviews of diagnostic test accuracy in imaging research: evaluation of current practices.

PURPOSE: The purpose of this methodological review was to determine the extent to which comparative imaging systematic reviews of diagnostic test accuracy (DTA) use primary studies with comparative or non-comparative designs. METHODS: MEDLINE was used to identify DTA systematic reviews published in imaging journals between January 2000 and May 2018. INCLUSION CRITERIA: systematic reviews comparing at least two index tests (one of which was imaging-based); review characteristics were extracted. Study design and other characteristics of primary studies included in the systematic reviews were evaluated. RESULTS: One hundred three comparative imaging reviews were included; 11 (11%) included only comparative studies, 12 (11%) included only non-comparative primary studies, and 80 (78%) included both comparative and non-comparative primary studies. For reviews containing both comparative and non-comparative primary studies, the median proportion of non-comparative primary studies was 81% (IQR 57-90%). Of 92 reviews that included non-comparative primary studies, 86% did not recognize this as a limitation. Furthermore, among 4182 primary studies, 3438 (82%) were non-comparative and 744 (18%) were comparative in design. CONCLUSION: Most primary studies included in comparative imaging reviews are non-comparative in design and awareness of the risk of bias associated with this is low. This may lead to incorrect conclusions about the relative accuracy of diagnostic tests and be counter-productive for informing guidelines and funding decisions about imaging tests. KEY POINTS: • Few comparative accuracy imaging reviews include only primary studies with optimal comparative study designs. Among the rest, few recognize the risk of bias conferred from inclusion of primary studies with non-comparative designs. • The demand for accurate comparative accuracy data combined with minimal awareness of valid comparative study designs may lead to counter-productive research and inadequately supported clinical decisions for diagnostic tests. • Using comparative accuracy imaging reviews with a high risk of bias to inform guidelines and funding decisions may have detrimental impacts on patient care.

Perceptions of competency-based medical education from medical student discussion forums.

BACKGROUND: Competency-based medical education (CBME) is becoming widely implemented in medical education. Trainees' perceptions of CBME are important factors in the implementation and acceptance of CBME. Online discussion groups allow unique insight into trainees' perceptions of CBME during residency training. METHODS: We analysed 867 posts from 20 discussion threads in Premed 101 (Canadian) and 2756 posts from 50 threads in Student Doctor Network (SDN) (American) using NVivo 11. Inductive content analysis was used to develop a data-driven coding scheme that evolved throughout the analysis. Measures were taken to ensure the trustworthiness of findings, including co-coding of a subsample of 600 posts, peer debriefing, consensus-based analytical decision making and the maintenance of an audit trial. RESULTS: Medical residents and students participating in the discussion forums emphasised select themes regarding the implementation of CBME in residency training. Concerns about CBME in Canada primarily involved its implications for the length of residency and post-residency opportunities. Posts on the American forum had a prominent focus on differing areas, such as the subjectivity in the assessment of core competencies and the role of CBME in termination of a resident's position. CONCLUSIONS: Online discussion groups have the potential to provide unique insight into perceptions of CBME. The presented concerns may have implications for refining the model of CBME and illustrate the importance of providing clarification for trainees regarding length of training and evaluation structures from those involved in designing of CBME programmes.

Completeness of Reporting of Systematic Reviews of Diagnostic Test Accuracy Based on the PRISMA-DTA Reporting Guideline.

BACKGROUND: We evaluated the completeness of reporting of diagnostic test accuracy (DTA) systematic reviews using the recently developed Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA)-DTA guidelines. METHODS: MEDLINE® was searched for DTA systematic reviews published October 2017 to January 2018. The search time span was modulated to reach the desired sample size of 100 systematic reviews. Reporting on a per-item basis using PRISMA-DTA was evaluated. RESULTS: One hundred reviews were included. Mean reported items were 18.6 of 26 (71%; SD = 1.9) for PRISMA-DTA and 5.5 of 11 (50%; SD = 1.2) for PRISMA-DTA for abstracts. Items in the results were frequently reported. Items related to protocol registration, characteristics of included studies, results synthesis, and definitions used in data extraction were infrequently reported. Infrequently reported items from PRISMA-DTA for abstracts included funding information, strengths and limitations, characteristics of included studies, and assessment of applicability. Reporting completeness was higher in higher impact factor journals (18.9 vs 18.1 items; P = 0.04), studies that cited PRISMA (18.9 vs 17.7 items; P = 0.003), or used supplementary material (19.1 vs 18.0 items; P = 0.004). Variability in reporting was associated with author country (P = 0.04) but not journal (P = 0.6), abstract word count limitations (P = 0.9), PRISMA adoption (P = 0.2), structured abstracts (P = 0.2), study design (P = 0.8), subspecialty area (P = 0.09), or index test (P = 0.5). Abstracts with a higher word count were more informative (R = 0.4; P < 0.001). No association with word counts was observed for full-text reports (R = -0.03; P = 0.06). CONCLUSIONS: Recently published reports of DTA systematic reviews are not fully informative when evaluated against the PRISMA-DTA guidelines. These results should guide knowledge translation strategies, including journal level (e.g., PRISMA-DTA adoption, increased abstract word count, and use of supplementary material) and author level (PRISMA-DTA citation awareness) strategies.