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.

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.

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.

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.

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.

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.

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.

Auditing RadExam: Employing Psychometrics to Improve Exam Quality.

INTRODUCTION: RadExam is a question item and exam database jointly developed by the Association of Program Directors in Radiology and the American College of Radiology to provide formative resident assessment, offering performance metrics benchmarked against institutional and national resident performance. Beyond resident performance, data is available on question and exam performance. Despite considerable investment in the education and training of its question writers and editors and meticulous attention to current psychometrically validated methods, it was anticipated a minority of exam questions would still perform poorly. Audits were performed to identify these questions, identify reasons for poor performance, and modify or replace so-affected questions. Exam performance was also assessed. METHODS: Two audits were performed, the first after the February-May 2018 RadExam pilot phase, and the second nearly 1 year after the full implementation of RadExam. In each audit, RadExam subspecialty editors evaluated all exam questions and exams using statistical data: question and test number of administrations, question p value, question Discrimination Index (DI), question Bloom's taxonomy learning level, exam P-value, and the number of image-based questions in each exam. Identified questions were modified or removed and replaced. RESULTS: Audit 1 was performed after the administration of 3114 exams comprised of 2520 questions administered across 100 residency programs. Audit 1 identified 617 questions with DI <0.1 and 565 questions with unacceptable P-values, all of which were modified or replaced. Audit 2 was performed after the administration of 16,416 exams, comprised of 2,507 questions. Audit 2 identified 229 questions with DI <0.1 and 290 questions with unacceptable P-values, representing a 49.1% decrease in total flagged questions compared to Audit 1. Statistically significant decreases were seen in questions with both DI and P-values outside of the desired range across nearly all subspecialties. CONCLUSION: The positive impact of our audit system on question and exam performance was reflected in a significant decrease in the number of questions flagged and improved overall exam performance in Audit 2. This illustrates the positive impact of Audit 1.

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.

Harnessing the Power of Low-tech Collaborative Learning.

Medical education in the United States has undergone a paradigm shift from passive learning to more interactive student-centered teaching methods. Several digital tools and platforms have been developed to assist educators in creating a high-tech, interactive classroom. However, there are many low-tech ways to engage learners and improve retention by combining collaborative learning techniques and summary exercises. Collaborative learning is an educational approach that involves the coordinated engagement of two or more learners for the purpose of completing a task or solving a problem. Such methods use a student-centered active learning model to promote higher-order cognitive tasks through active engagement in course content. Additionally, summary exercises at the end of a learning activity promote reflection and retention of learned concepts while clarifying content that may have been confusing for the learner. The purpose of this article is to describe the methodology and tips for the implementation of low-tech collaborative learning methods and summary activities into trainee educational activities to create an engaging student-centered learning environment.

Development of Breast Imaging Specific Entrustable Professional Activities Using a Double Delphi Technique.

RATIONAL AND OBJECTIVES: To develop subspecialty-specific entrustable professional activities for breast imaging radiology (EPA-BRs) through the use of a double consensus-driven, validity-enhancing methodology that may be relevant to other subspecialties in radiology and medicine in general. MATERIALS AND METHODS: A six-step methodology was used to develop EPA-BRs via a double Delphi process followed by educational theorist's refinement. Two groups of experts completed each Delphi process: the core group of breast imaging educators and an expert panel of national experts in breast imaging standards and appropriateness. RESULTS: Five EPA-BRs were developed, with eight nested EPA-BRs, one of which is elective. This comprehensive list of EPA-BRs covers the role of a breast imaging radiologist in the care of a patient from detection of breast cancer to post-treatment follow-up. CONCLUSION: A combined modified and classic double Delphi approach can be utilized by other graduate medical education (GME) specialties and subspecialties as a method by which GME education can be transformed into a clinical framework that more closely bridges individual competencies and real-world clinical practice.

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.