Preparing and Promoting Women for Leadership Positions in Radiology and the Imaging Industry.

A dearth of women leaders in the field of radiology and affiliated industries persists despite a recognition of the importance, value, and impact that would derive from its rectification. A targeted educational collaboration, described herein, was established between academia and industry to address this deficit and to facilitate the placement of highly qualified women into leadership positions. The actionable platform offered has the potential to narrow the gap for underrepresented groups in professional leadership positions.

Perspective: Mandatory Radiology Education for Medical Students.

Radiology education of medical students is increasingly important given the intersection of radiology with virtually all medical specialties and integral role of imaging in modern patient care. Yet radiology education requirements in US medical schools are variable with only a minority of schools requiring a clerkship in radiology. When required, the radiology curriculum is often limited to anatomy courses in the preclinical years or partially incorporated into required core clerkships and often taught by nonradiologists. Given the growing mandate for value-based care and emphasis on patient outcomes, medical students require better imaging education, both interpretive and non-interpretative skills. They should be taught how to apply appropriateness criteria for exam ordering and the relative costs of different imaging modalities given the economic implications of imaging overutilization. Medical students should also be educated regarding imaging safety considerations. In addition, they must learn the radiologist's role as consultant to assure appropriate ordering of imaging studies, oversight for performance of diagnostic exams and image-guided procedures, interpretation of studies, and communication of results. Increasing radiologist teaching and engagement with medical students also has the potential to improve diversity and inclusivity in radiology by increasing interest in the specialty as physicians who identify as underrepresented minorities (URMs) are more likely to practice in underserved areas and with underserved populations thus addressing healthcare disparities and improving access to healthcare for those patient populations. Medical schools should support preclinical and clinical curricula that is designed and taught by radiologists.

Approaches to Greening Radiology.

The health care sector is a resource-intensive industry, consuming significant amounts of water and energy, and producing a multitude of waste. Health care providers are increasingly implementing strategies to reduce energy use and waste. Little is currently known about existing sustainability strategies and how they may be supported by radiology practices. Here, we review concepts and ideas that minimize energy use and waste, and that can be supported or implemented by radiologists.

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.

A survey-based evaluation of the radiology residency interview process.

PURPOSE: The aim of this study was to assess the diagnostic radiology residency interview process and determine variability among programs in their approach to interviewing candidates. METHODS: A survey of the residency interview process was sent to diagnostic radiology program directors through an e-mail address list provided by the Association of Program Directors in Radiology. Questions addressed were (1) the number of applicants interviewed per residency position offered; (2) the number of interviews scheduled for each applicant on the interview day; (3) whether interviews were performed by staff members, residents, or both; and (4) whether interviewers were granted time away from clinical services to interview applicants. RESULTS: Two electronic mailings were sent to 313 individuals. Responses were received from 89 of 188 accredited diagnostic radiology residency programs (response rate, 47.3%). The average number of interviews per residency position was 12.6 (range, 3-28), with university-based programs interviewing significantly fewer candidates (mean, 11.5) than non-university-based programs (mean, 15.3). The average number of individual interviews during the interview day was 3.9 (range, 1-8) per candidate at each program. Of responding programs, 69% of responding programs included residents in interviews, and 67% compensated their interviewing staff members with time off clinical service, with no statistical difference between large and small programs. CONCLUSION: There is a large amount of variability present in the residency interview process. Applicants to programs may have very different experiences while visiting programs. Further study of this variation may allow programs to optimize resource utilization while maintaining success in the match process.

Do students' and authors' genders affect evaluations? A linguistic analysis of Medical Student Performance Evaluations.

PURPOSE: Recent guidelines for the Medical Student Performance Evaluation (MSPE) have standardized the "dean's letter." The authors examined MSPEs for linguistic differences according to student or author gender. METHOD: This 2009 study analyzed 297 MSPEs for 227 male and 70 female medical students applying to a diagnostic radiology residency program. Text analysis software identified word counts, categories, frequencies, and contexts; factor analysis detected patterns of word categories in student-author gender pairings. RESULTS: Analyses showed a main effect for student gender (P=.046) and a group difference for the author-student gender combinations (P=.048). Female authors of male student MSPEs used the fewest "positive emotion" words (P=.006). MSPEs by male authors were shorter than those by females (P=.014). MSPEs for students ranked in the National Resident Matching Program contained more "standout" (P=.002) and "positive emotion" (P=.001) words. There were no differences in the author-gender pairs in the proportion of students ranked, although predominant word categories differed by author and student gender. Factor analysis revealed differences among the author-student groups in patterns of correlations among word categories. CONCLUSIONS: MSPEs differed slightly but significantly by student and author gender. These differences may derive from societal norms for male and female behaviors and the subsequent linguistic interpretation of these behaviors, which itself may be colored by the observer's gender. Although the differences in MSPEs did not seem to influence students' rankings, this work underscores the need for awareness of the complex effects of gender in evaluating students and guiding their specialty choices.

Student interviews for radiology residency: what influences how students rank programs?

All radiology programs wish to attract the highest quality candidates to their radiology residencies. Departments expend considerable resources on Electronic Residency Application Service application reviews and student interviews. An important component of the interview day is to display program, faculty, and resident strengths to students. Through a series of surveys administered to students interviewing at the authors' program as well as 50 other programs nationwide, the authors identified factors that may significantly affect how students rank programs at the time of the match. Although many of these factors are unchangeable, such as geography, others can be modified. Key factors identified included the friendliness and approachability of residents and faculty members, teaching, research opportunities, the strength of the interventional radiology department, and call schedules. As a result of reviewing how students perceive radiology programs, the interview day at the authors' institution has been significantly restructured, and current residents now play a larger role in the candidate evaluation process.

Resident duty hour limits: recommendations by the IOM and the response from the radiology community.

The Accreditation Council for Graduate Medical Education (ACGME) set duty hour limits across all specialties nationally in 2003 to promote safe patient care and resident well-being. At the request of Congress, the Institute of Medicine studied the issue of patient safety and resident work hours and recently issued a report calling for further restrictions on resident duty hours, better resident supervision, and new federal oversight of the ACGME in monitoring resident duty hours. The authors review the history behind the current ACGME requirements, outline the Institute of Medicine's recommendations, and report on the response from the radiology community.

Challenges and opportunities in restructuring radiology residencies: the APDR Residency Restructuring Committee report.

Changes to the ABR certification process are imminent, with a core examination after 36 months of training and a certifying examination 15 months after the completion of training replacing the current examination structure for residents entering training in July 2010 and beyond. The Residency Restructuring Committee of the Association of Program Directors in Radiology was developed to analyze the challenges and opportunities of these upcoming changes and provide recommendations to programs. The guidelines included in this article represent a summary of the work of this committee to date.

The diagnosis of gastroesophageal reflux disease.

BACKGROUND: Gastroesophageal reflux disease is a highly prevalent condition that imposes a significant economic impact on the US health care system. The utility of commonly used tests for the diagnosis of gastroesophageal reflux disease has not been adequately reviewed. METHODS: A comprehensive review of the literature was undertaken to provide an evidence-based approach to the diagnosis of gastroesophageal reflux disease. EMBASE (1980-December 2008), OVID MEDLINE, and PubMed, (1966-December 2008) were searched using "gastroesophageal reflux" and "adults" with other terms, including medications, diagnostic tests, symptoms, and epidemiologic terms. Studies were limited to human trials, English language, and full articles. RESULTS: Heartburn is a reasonably sensitive symptom for the diagnosis of gastroesophageal reflux disease, although it does not reliably predict esophagitis. Standardized questionnaires have limited specificity, whereas the double-contrast barium swallow has a low sensitivity to diagnose gastroesophageal reflux. The role of esophageal manometry is limited to accurate placement of a pH-measuring device. pH testing has reasonable sensitivity and specificity for the diagnosis of gastroesophageal reflux disease. The sensitivity of upper endoscopy to diagnose gastroesophageal reflux is lower than that of pH tests. CONCLUSION: The diagnosis of gastroesophageal reflux disease remains difficult. In the absence of alarm symptoms, empiric treatment with acid suppression is warranted. pH testing provides valuable information in many patients, although the clinical utility of newer tests needs to be determined. Endoscopy should not be the first test used to diagnose gastroesophageal reflux.

Core curriculum: research ethics for radiology residents.

RATIONALE AND OBJECTIVES: Scholarly activity, which may include research, is now a required element of resident training. In addition, residents are required to participate in a systems-based practice or quality improvement project. Residency programs are expected to provide training for these endeavors but may lack the necessary resources. This work is intended to provide a core curriculum in research ethics for radiology residents to help fulfill that need. MATERIALS AND METHODS: The material was developed through discussion and collaboration of the authors, review of pertinent literature, and consultation with experts in the field. RESULTS: This work includes a brief introduction to the topic, followed by cases designed to highlight the issues inherent in informed consent, privacy, the disclosure of results, authorship, study subjects, and health services research. CONCLUSION: Radiology residents are expected to learn about the design, performance, reporting, and critical evaluation of research. All of these elements can potentially raise ethical issues. Understanding the underlying ethical issues is critical for the future of radiology research.

Hemoconcentration and pancreatic necrosis: further defining the relationship.

OBJECTIVES: In the setting of acute pancreatitis, an admission hematocrit greater than or equal to 44% and/or a failure of hematocrit to drop at 24 hours have been reported as useful markers to predict subsequent necrosis. We aimed to validate the use of hemoconcentration as a marker to predict necrosis in adult patients presenting with acute pancreatitis. METHODS: Patients admitted to our medical center from 1990 to 2003 with a first presentation of acute pancreatitis were identified. Charts were abstracted for baseline demographic and clinical information, including admission and 24-hour hematocrit, and subsequent hospital course. Necrosis was determined based on computed tomography scan. We calculated the sensitivity, specificity, positive and negative predictive values (NPV) for different admissions, and 24-hour hematocrit levels in predicting the subsequent development of necrosis. RESULTS: Two hundred thirty patients were identified. Admission hematocrit (> or = 44%) was a poor predictor of subsequent necrosis with a sensitivity of 52.9%. The absence of hemoconcentration at admission or a drop in 24-hour hematocrit level was reliable in predicting that patients would not develop necrosis (NPV of 94.7% for hematocrit > or = 44%). Results were similar when we compared a range of admission and 24-hour hematocrit values. CONCLUSIONS: In a community setting with low rates of necrosis, admission and 24-hour hematocrit levels were not helpful in predicting subsequent necrosis. The absence of admission hemoconcentration had strong NPV for necrosis. However, the actual clinical utility of this test to direct clinical decision making may be limited.