Using a Nationwide Virtual Radiology Student Interest Group to Expand Medical Students' General Awareness, Drive Greater Interest, and Achieve Uniform National Messaging in the Field of Radiology.

RATIONALE AND OBJECTIVES: Many medical schools offer minimal exposure to radiology, leading to a decreased understanding of the field and negative perceptions among medical students. The purpose of this study was to examine the effects of a radiology intensive series piloted by a novel virtual radiology interest group. Specifically, we were interested in how radiologists and medical educators can expand students' general awareness, drive greater interest in the field, and achieve more uniform national messaging across all trainees. MATERIALS AND METHODS: We launched a national/international interest group called Radiology Student Interest Group (RadSIG) and piloted the RadSIG Intensive, a series of five events aimed at increasing awareness and dispelling misconceptions among preclinical medical students. Validated pre-intensive and post-intensive surveys were used to ascertain the students' baseline and changed perspectives, respectively. A separate faculty survey was also distributed to understand how they perceived our events. Statistical analysis was carried out on the collected data to identify trends and assess the utility of our programming. RESULTS: 205 students completed the pre-intensive survey, and 61 students completed the post-intensive survey. Of the pre-intensive survey respondents, 51.7% (106/205) indicated that they had a limited understanding of what a career in radiology entails. Of those who completed the entire RadSIG Intensive, average 5-point Likert scale scores for understanding of a radiology career rose from 3.30 to 4.38 respectively pre- to post-completion. A Wilcoxon signed-rank test revealed that this difference was statistically significant (Z=-5.95, p<0.001), and that the RadSIG Intensive significantly improved perceptions of radiologists across every single question measured, except for perception of long hours worked (Z=-0.20, p=0.841). The results also showed increased student comfort in reaching out to radiology attendings (Z=-4.30, p<0.001) and residents (Z=-5.12, p<0.001). Faculty survey results indicated positive perceptions of the series. CONCLUSION: Our results show that the RadSIG Intensive was effective in increasing students' understanding of radiology as a field and a potential career. Online outreach can also lower the resistance and improve student comfort in reaching out for mentorship, which may provide a new pathway to reach underserved students with a unifying message. By furthering a platform based on voluntary and supplemental resources, we see a far greater potential of impacting the perception and known role of the imager in patient care among our next generation of physicians.

Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary.

Background: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for-profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit-affiliated programs, as investor obligations could make for-profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for-profit affiliated residency programs from 2001-2021 and determine if PGY1 salaries differ between these program types. Methods: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001-2021 were used to quantify the growth of both for-profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021-2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables. Results: The number of EM programs increased from 117 to 276 from 2001-2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016-2021. Mean for-profit affiliated program salary ($55,658, n  = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n  = 203). For-profit affiliation was a significant predictor of lower 2021-2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß  = -1919.88, P = 0.010). Conclusions: We found a substantial growth of newly ACGME accredited for-profit affiliated EM residency programs from 2016-2021. We also found for-profit affiliated programs pay lower PGY1 salaries than nonprofit-affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.

Quantifying For-Profit Outcomes in GME: A Multispecialty Analysis of Board Certifying Examination Pass Rates in For-Profit Affiliated Residency Programs.

Background: The number of for-profit hospitals has increased in the United States, but their role in and outcomes for graduate medical education (GME) are unclear. Objectives: To describe for-profit involvement in internal medicine (IM), general surgery (GS), and pediatrics GME by quantifying change in for-profit affiliated residency programs and comparing for-profit and nonprofit affiliated program board certifying examination pass rates. Methods: We used Accreditation Council for Graduate Medical Education and Medicare data to quantify for-profit prevalence in IM, GS, and pediatrics GME from 2001 to 2021. We used public pass rate data from the American Board of Surgeons (2017-2019; n=242 programs; 6562 examinees), American Board of Internal Medicine (2018-2020; n=465 programs; 23 922 examinees), and American Board of Pediatrics (2018-2020; n=202 programs; 9819 examinees) to model the relationship between profit status and pass rate within each specialty and across specialties combined using linear regression. Results: The proportion of for-profit affiliated residency programs increased 400.0% in IM, 334.4% in GS, and 23.2% in pediatrics from 2001 to 2021. Bivariate linear regression revealed significantly lower pass rate in for-profit affiliated programs in IM ß =-7.73, P<.001), pediatrics (ß =-14.6, P<.001), and the 3 specialties combined (ß =-5.45, P<.001). Upon multiple regression with addition of program characteristic covariates, this relationship remained significant in pediatrics (ß =-10.04, P=.006). Conclusions: The proportion of for-profit affiliated residency programs has increased in IM, GS, and pediatrics from 2001 to 2021. After controlling for covariates, for-profit affiliated programs were associated with lower board examination pass rates in pediatrics with no association in IM, GS, or the combined measure.

Advanced Practice Providers and Wait Times in Urology Offices: A Secret Shopper Study.

INTRODUCTION: Advanced practice providers (APPs), such as nurse practitioners and physician assistants, are a growing part of urology practices. However, the impact of APPs on improving new patient access in urology is unknown. We examined the impact of APPs on new patient wait times in a real-world sample of urology offices. METHODS: Research assistants posing as caretakers called urology offices in the Chicago metropolitan area and attempted to schedule a new patient appointment for an elderly grandparent with gross hematuria. Appointments were requested with any available provider: physician or APP. Descriptive measurements of clinic characteristics were reported and differences in appointment wait times were determined using negative binomial regressions. RESULTS: Of the 86 offices with which we scheduled appointments, 55 (64%) employed at least 1 APP but only 18 (21%) allowed for new patient appointments with APPs. When requested for the earliest appointment regardless of provider type, offices with APPs could offer shorter wait times compared to physician-only offices (10 vs 18 days; p=0.09). Initial appointments with an APP were available with a significantly shorter wait than those with a physician (5 days vs 15 days; p=0.04). CONCLUSIONS: Urology offices are commonly employing APPs but giving them a limited role in new patient visits. This suggests that offices with APPs may have an unrealized opportunity to improve new patient access. Further work is needed to better elucidate the role of APPs in these offices and how they might best be deployed.

Naegleria fowleri: Protein structures to facilitate drug discovery for the deadly, pathogenic free-living amoeba.

Naegleria fowleri is a pathogenic, thermophilic, free-living amoeba which causes primary amebic meningoencephalitis (PAM). Penetrating the olfactory mucosa, the brain-eating amoeba travels along the olfactory nerves, burrowing through the cribriform plate to its destination: the brain's frontal lobes. The amoeba thrives in warm, freshwater environments, with peak infection rates in the summer months and has a mortality rate of approximately 97%. A major contributor to the pathogen's high mortality is the lack of sensitivity of N. fowleri to current drug therapies, even in the face of combination-drug therapy. To enable rational drug discovery and design efforts we have pursued protein production and crystallography-based structure determination efforts for likely drug targets from N. fowleri. The genes were selected if they had homology to drug targets listed in Drug Bank or were nominated by primary investigators engaged in N. fowleri research. In 2017, 178 N. fowleri protein targets were queued to the Seattle Structural Genomics Center of Infectious Disease (SSGCID) pipeline, and to date 89 soluble recombinant proteins and 19 unique target structures have been produced. Many of the new protein structures are potential drug targets and contain structural differences compared to their human homologs, which could allow for the development of pathogen-specific inhibitors. Five of the structures were analyzed in more detail, and four of five show promise that selective inhibitors of the active site could be found. The 19 solved crystal structures build a foundation for future work in combating this devastating disease by encouraging further investigation to stimulate drug discovery for this neglected pathogen.