Diversity, Equity, and Inclusion Programs in Radiology: Data-Driven Strategies for Success, From the AJR Special Series on DEI.

Radiology practices nationwide have implemented diversity, equity, and inclusion (DEI) programs seeking to change the landscape of a field traditionally dominated by White men. However, measuring these programs' success is often challenging, and a lack of documented success may threaten such programs' ongoing growth. This article explores the application of metrics and overall concepts from the business world to assess the success of DEI programs in radiology practices. Metrics and processes are described for each area, including demographic data for measuring diversity, compensation and leadership representation data for measuring equity, and survey-based data for measuring inclusion. A practical data-driven framework is presented that radiology practices may adapt to their DEI programs. This framework is centered on critical assessment of a practice's current shortcomings and creation of leadership accountability to track progress and effect real change. Through the spectrum of considerations highlighted in this article, DEI programs can have a large impact in driving measurable success for radiology practices and ultimately the specialty at large.

Women's response to state-mandated language in dense breast notification.

Many states require radiologists to notify women of dense breast status. Our aim was to elicit women's response to state-mandated dense breast notification language. Of respondents, 82% report that current notification does not inform them of additional screening studies available, and 41% report notification does not inform them of next steps. Open-ended responses indicate three main areas of patient concern: Decisional Needs, Decision Quality, and Decision Support. We modified an existing Decision Support framework to capture additional themes specific to dense breast decisions. The developed framework can be used to revise and improve current breast density reporting methods.

Development of a Standardized Kalamazoo Communication Skills Assessment Tool for Radiologists: Validation, Multisource Reliability, and Lessons Learned.

OBJECTIVE: The purpose of this study was to develop and test a standardized communication skills assessment instrument for radiology. MATERIALS AND METHODS: The Delphi method was used to validate the Kalamazoo Communication Skills Assessment instrument for radiology by revising and achieving consensus on the 43 items of the preexisting instrument among an interdisciplinary team of experts consisting of five radiologists and four nonradiologists (two men, seven women). Reviewers assessed the applicability of the instrument to evaluation of conversations between radiology trainees and trained actors portraying concerned parents in enactments about bad news, radiation risks, and diagnostic errors that were video recorded during a communication workshop. Interrater reliability was assessed by use of the revised instrument to rate a series of enactments between trainees and actors video recorded in a hospital-based simulator center. Eight raters evaluated each of seven different video-recorded interactions between physicians and parent-actors. RESULTS: The final instrument contained 43 items. After three review rounds, 42 of 43 (98%) items had an average rating of relevant or very relevant for bad news conversations. All items were rated as relevant or very relevant for conversations about error disclosure and radiation risk. Reliability and rater agreement measures were moderate. The intraclass correlation coefficient range was 0.07-0.58; mean, 0.30; SD, 0.13; and median, 0.30. The range of weighted kappa values was 0.03-0.47; mean, 0.23; SD, 0.12; and median, 0.22. Ratings varied significantly among conversations (χ26 = 1186; p < 0.0001) and varied significantly by viewing order, rater type, and rater sex. CONCLUSION: The adapted communication skills assessment instrument is highly relevant for radiology, having moderate interrater reliability. These findings have important implications for assessing the relational competencies of radiology trainees.

What Program Directors Think About Resident Recruitment: Results of the 2023 Spring Survey of the Association of Program Directors in Radiology (APDR) Part I.

RATIONALE AND OBJECTIVES: The Association of Program Directors in Radiology (APDR) administers an annual survey to assess issues and experiences related to residency program management and education. Our purpose is to provide the response data from the 2023 survey and discuss its insights on the impact of COVID-19 on resident recruitment (Part I) and education (Part II), which can be used to facilitate planning and resource allocation for the evolving needs of programs and their leadership. In Part I, we consider the effects of ERAS preference signaling, the virtual interview format, and the potential of a universal interview release date. MATERIALS AND METHODS: An observational, cross-sectional study of the APDR membership was performed using a web-based survey consisting of 45 questions, 23 of which pertain to virtual recruitment and are discussed in Part I of a two-part survey analysis. All active APDR members (n = 393) were invited to participate in the survey. RESULTS: The response rate was 32% (124 of 393). 83% reported that signaling increased the likelihood of an interview offer. 96% reported only offering virtual interviews; however, 59% intended to offer virtual-only interviews in the future. 53% would adhere to a universal interview release date but an additional 44% would do so depending on the agreed date, Results were tallied using Qualtrics software and qualitative responses were tabulated or summarized as comments. CONCLUSIONS: Virtual recruitment is expected to continue for many programs and most respondents would accept a universal interview release date. Preference signaling and geographic signaling are considered positive additions to the application process.

What Program Directors Think About Resident Education: Results of the 2023 Spring Survey of the Association of Program Directors in Radiology (APDR) Part II.

RATIONALE AND OBJECTIVES: The Association of Program Directors in Radiology (APDR) administers an annual survey to assess issues and experiences related to residency program management and education. Response data from the 2023 survey provides insights on the impact of COVID-19 on resident recruitment (Part I) and education (Part II), which can be used to facilitate planning and resource allocation for the evolving needs of programs and their leadership. MATERIALS AND METHODS: An observational, cross-sectional study of the APDR membership was performed using a web-based survey consisting of 45 questions, 12 of which pertain to resident education in the post-pandemic era and are discussed in Part II of a two-part survey analysis. All active APDR members (n = 393) were invited to participate in the survey. RESULTS: The response rate was 32% (124 of 393). Results were tallied using Qualtrics software and qualitative responses were tabulated or summarized as comments. CONCLUSIONS: The primary challenges to resident education are faculty burnout, rising case volumes, and remote instruction. However, most program leaders report that in-person readouts are much more common than remote readouts. The ability to offer both in-person and remote AIRP sessions is viewed positively. Most program leaders require Authorized User certification, although many do not think all residents need it. Assessment of procedural competence varies by the type of procedure and is similar to graduates' self-assessment of competence.

Professionalism Training in the Post-COVID-19 Era.

INTRODUCTION: Professionalism is one of the ACGME core competencies for radiology residency training. The COVID-19 pandemic has changed the way resident education and training occurs. The primary objective of this study was to perform a comprehensive systematic review of the literature pertaining to adapting professionalism training in radiology residency to the post-COVID-19 era education landscape. METHODS: We reviewed English-language medicine and health services literature for research that described professionalism training in radiology residency in the post-COVID-19 era radiology search terms and key words in PubMed/MEDLINE and Scopus/Elsevier. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: The search yielded a total 33 articles. We reviewed the citations and abstracts with the initial search yielding 22 articles (without duplicates). Of these, 10 were excluded based on the criteria set forth in the methods. The remaining unique 12 articles were included for qualitative synthesis. DISCUSSION: This article should provide radiology educators with the tool they need to effectively education and evaluate radiology residents on professionalism in the post-COVID-19 era.

Radiology program director's perspective on a novel hands-on advanced elective.

With the advent of the USMLE Step 1 exam moving to a pass/fail status, Radiology Program Directors (PDs) and Associate Program Directors (APDs) need alternative methods of identifying interested and engaged medical students who are applying to their program. Additionally, undergraduate radiology medical education in the United States varies widely from institution to institution with no universal mandatory radiology component. To address these problems, we implemented an advanced fourth year hands-on radiology elective where the students were treated as first year radiology residents (R1s), giving them resident-level access to the Picture Archive and Communication System (PACS) and dictation software, and allowing them to perform entry-level procedures with appropriate supervision. After implementation of the elective, a 5-question online survey was sent to two hundred and ninety-eight PDs and APDs via the Association of Program Directors in Radiology (APDR) listserv, of which seventy-two responses were compiled, yielding a response rate of 24%. The survey focused on how a hands-on medical student elective would help in assessing prospective candidates and predicting R1 performance. Most respondents felt interest in radiology, motivation, and interpersonal skills would be better assessed after such an elective and the vast majority felt hands-on Advanced Elective would be at least slightly predictive of first year resident performance. Based on this information, we believe implementing a hands-on advanced radiology elective would significantly help address the passive nature of traditional radiology electives, providing valuable information to PDs and APDs and giving the best possible radiology experience to our medical students.

Resident Perspective of the Virtual Diagnostic Radiology Residency Interview Process: A National Survey From the Association of Program Directors in Radiology.

RATIONALE AND OBJECTIVES: The purpose of this study was to assess differences in first-year radiology resident perception of the match process and early satisfaction with residency programs between those who matched in 2020 versus 2021, the first virtual application cycle after the start of the COVID-19 pandemic. MATERIALS AND METHODS: A 33-question survey was distributed to first-year diagnostic radiology residents at programs throughout the United States through the Association of Program Directors in Radiology. Responses were collected in June of 2022 from residents who matched in 2020 and in July of 2022 from residents who matched in 2021. Questions were designed to assess applicant demographics, outcomes and attitudes towards the interview process. Comparison was made between the two cohorts. RESULTS: Of the 2231 matched residents in the 2020 and 2021 match years, 108 residents (4.8%) received, responded, and met inclusion criteria for the survey. Forty-three of 46 (92.5%) respondents that matched in 2020 interviewed in-person compared to one of 60 (1.7%) that matched in 2021 (p < 0.0001). There was no difference in satisfaction of match results, current training programs, work culture, satisfaction with facilities, and depiction of residency structure. Applicants from the 2021 cohort were more likely to express concerns about interview hoarding, having enough time to ask questions on interview days, and ability to accurately present themselves in interviews but were more likely to favor virtual interviews for future cycles. CONCLUSION: The virtual interview process is perceived neutrally or positively by most early diagnostic radiology residents and produced similar satisfactory results compared to applicants that interviewed in person. Attention should be given to concerns of those who matched virtually if the virtual interview process is to be continued.

APDR Healthcare Disparities Curriculum Pilot: Helping Trainees Meet More Than a Milestone.

RATIONALE AND OBJECTIVES: In order to help program directors satisfy the Accreditation Council for Graduate Medical Education common program requirement for health care disparities (HCD) education, a comprehensive web-based curriculum on HCDs in Radiology was developed. The curriculum was designed to educate trainees about existing HCDs, stimulate discussion, and spur research about HCDs in radiology. The curriculum was piloted to assess its educational value and feasibility. MATERIAL AND METHODS: A comprehensive curriculum comprised of four modules (1) Introduction to HCDs in Radiology, (2) Types of HCDs in Radiology, (3) Actions to Address HCDs in Radiology, and (4) Cultural Competency was created and housed on the Associate of Program Directors in Radiology website. Various educational media including recorded lectures or PowerPoint presentations, small group discussions, and journal clubs were employed. A pilot program was initiated to evaluate the benefits of this curriculum for resident education and consisted of a pre- and post-curriculum test for trainees, an experience survey for trainees, and a pre- and post-administration survey for facilitators. RESULTS: Forty-seven radiology residency programs participated in the pilot of the HCD curriculum. Of those facilitating the curriculum, 83% indicated lack of standardized curriculum as a perceived barrier to implementing a HCD curriculum at their program on the pre-survey. Trainee knowledge scores increased from 65% (pre) to 67% (post) (p = 0.05). Following curriculum participation, residents indicated an increase in adequate understanding of HCDs in Radiology (81% post vs. 45% pre). Most program directors (75%) found the curriculum easy to implement. CONCLUSION: This pilot study demonstrated that the APDR Health Care Disparities curriculum increased trainee awareness of HCDs. The curriculum also provided a forum for important discussions about HCDs.

MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes.

Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis.

Breaking the Stereotype: Interventions Aimed at Changing Medical Student Misperceptions of Radiology and Increasing the Female Match Rate.

BACKGROUND: Although nearly half of medical students are female there is still a significant discrepancy in the number of women specializing in radiology. In 2013, 26.9% of US diagnostic radiology residents were female, a 1% increase in 20 years from 25.5% in 1990. PURPOSE: The purpose of this project is to determine the effectiveness of the interventions implemented at a single medical school at decreasing negative attitudes about radiology held by medical students of all genders and whether those same interventions will increase the number of female medical students matching into radiology. METHODS: The interventions were implemented between 2012 and 2016 and included incorporation of radiology into preclinical curriculum, electives in radiology for 3rd year students, a "Women in Radiology Panel," and increase in female radiology faculty visibility. First year medical student participants of all genders used a free text box to write their attitudes about radiology, which were categorized into the "six most common attitudes about radiology." Fourth year medical student participants used a free text box to write the reasons why they did not choose radiology as a specialty, and those answers were then placed into the same six categories. We then analyzed the data using Fisher's Exact Test to determine whether there was a decrease in the negative misperceptions after exposure to the interventions. We also then determined whether there was an increase in the number of women matching into radiology using Chi-Square analysis. RESULTS: There was a decrease in the negative misperceptions between 1st and 4th years, with the most notable decrease from 51% of 1st years to 0% of 4th years listing radiologists as being antisocial (p < 0.01). There was also a significant increase in the number of female medical students matching into radiology in the years in which students were exposed to 4 years of intervention when compared to three and fewer (0.76%-4.2%, p = 0.01). CONCLUSION: Exposure to 4 years of the interventions demonstrated a significant increase in the female match rate into the specialty when compared to female medical students who experienced three or fewer years of intervention. Additionally, it appears that these same interventions decreased the number of students of all genders having some of the common negative misperceptions about the field of radiology.

Artificial intelligence-based decision support system (AI-DSS) implementation in radiology residency: Introducing residents to AI in the clinical setting.

PURPOSE: The aim of this study was to evaluate residents' real-time experiences and perceptions in using artificial intelligence-based decision support system (AI-DSS) applications in the clinical setting and provide recommendations on how to improve artificial intelligence (AI) curriculums in residency programs. METHODS: We implemented AI-DSS in our radiology workflow and integrated it into the radiology residency curriculum as a step in developing an AI-targeted curriculum. Fifteen senior residents were granted AI-DSS access for clinical use. Post-implementation, residents were anonymously surveyed to assess the utility of AI-DSS in addressing their learning needs and to determine the perceived impact of AI on their career choice and future professional development. RESULTS: Most residents (91.6%) support incorporating AI into the curriculum and found AI-DSS useful in supplementary roles of triaging (83.3%) and troubleshooting (66.7%), rather than for diagnostic purposes of speed (41.7%), accuracy (33.3%), or diagnosis determination (16.7%). Residents found it useful to have earlier exposure to AI (66.7%), although the exact timeline in training for when to introduce residents to AI-DSS was debated and unclear. Most residents (83.3%) had a positive outlook on the impact of AI on radiology and 50.0% were excited to further their understanding of AI. CONCLUSIONS: Our experience implementing AI-DSS in the clinical setting was a desirable and positive experience for our residents that will better prepare them as radiologists and help them capitalize on future opportunities in AI advancements. We hope our experience will provide incentive and guidance for other institutions to establish an AI program for their trainees.

Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes.

While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.

Health Care Disparities in Radiology-A Review of the Current Literature.

INTRODUCTION: Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS: We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION: We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.

Ensuring a Smooth Transition for Trainees Returning from Parental Leave - A Guide for Program Directors.

Transitioning from parental leave during radiology residency training can be a time of stress and uncertainty. However, there are ways that program directors can help make the transition smoother and less overwhelming. Trainees report numerous stressors upon returning from leave involving childcare, lactation concerns and logistics, and discrimination. Program directors can help alleveate these stressors by counseling trainees returning from parental leave and providing reseources and a supportive enviroment. This article provides a structured frame work with tool for programs directors to ensure the transition from parental leave back to training is a smooth one.

Strategies to Improve Racial and Ethnic Diversity in Breast Imaging Training and Beyond.

Diversity and inclusion in breast imaging can improve creativity and innovation, enrich the workplace environment, and enhance culturally appropriate care for an increasingly diverse patient population. Current estimates predict the racial and ethnic demographics of the United States population will change markedly by the year 2060, with increases in representation of the Black demographic projected to comprise 15% of the population (currently 13.3%) and the Hispanic/Latinx demographic projected to comprise 27.5% of the population (currently 17.8%). However, matriculation rates for those who are underrepresented in medicine (URM), defined as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population," have remained largely stagnant. Black students comprise only 7.1% of medical student matriculants, and Hispanic/Latinx students comprise only 6.2% of medical school matriculants compared to the general population. The matriculation rate of URM students into diagnostic radiology is even lower, with Black trainees comprising 3.1% of radiology residents and Hispanic/Latinx trainees comprising 4.8% of radiology residents. This lack of URM radiology resident representation leads to a lack of URM potential applicants to breast imaging fellowships due to the pipeline effect. Strategies to improve diversity and inclusion in breast imaging include recruiting a diverse breast imaging workforce, establishing robust mentorship and sponsorship programs, fostering an inclusive training and workplace environment, and retaining and promoting a diverse workforce.

Integrating art museum visits into the radiology curriculum: A program to encourage engagement, observation and analytic skills among millennial learners.

Millennial learners have unique educational preferences and expectations, many of which vary significantly from those of their predecessors. To aid in the preparation and training of the next generation of radiologists, we have been exploring a teaching technique using an art observation training workshop to foster engagement of millennial radiology residents to pay closer attention to image detail, clearly state the observations and synthesize the "story" of the patient's condition. Fine tuning these visual skills is crucial as research shows that over 70% of errors in interpreting diagnostic imaging studies are related to visual perception errors.

Mitigating Unconscious Bias in Recruitment and Hiring.

Unconscious biases in recruitment and hiring can limit the potential for building a diverse academic and private radiology practice. In the private practice environment of radiology, especially in smaller firms, in which a dysfunctional team can lead to a dysfunctional practice overall, it is especially essential to find the best candidates for the team. Many strategies for mitigating these biases can be employed strategically at multiple levels of the hiring process.