Creativity, Connection, and Community: Reimagining the Radiology Society Meeting.

RATIONALE AND OBJECTIVES: With the shifting needs of radiologists due to escalating healthcare demands, the impetus for an increased focus on wellness and the benefits of the humanities in medicine inspired a novel approach to curricular planning of the 2023 Association of University Radiologists (AUR) annual meeting. In this manuscript, we describe the creative process behind planning and executing this innovative meeting format. MATERIALS AND METHODS: Reimagining the annual meeting was a collaborative effort centered around the development of an innovative Arts and Wellness Program, with the goal of integrating opportunities for artistic expression and experiential wellness throughout the meeting. RESULTS: Of the 1313 meeting attendees, 423 (32.2%) completed the annual meeting evaluation, of which 244 were in-person and 61 attended virtually. 178 of 423 respondents (42.1%) participated in the arts and wellness programming. 160 of 203 respondents (78.9%) reported that the arts and wellness programming enhanced the overall meeting experience. 164 of 197 respondents (83.2%) gained greater appreciation for the talents of radiology colleagues. 97 of 195 respondents (49.7%) stated that the programming gave them ideas as to how to cope effectively with stress. CONCLUSION: The incorporation of art, music, and other wellness activities into a national radiology meeting was well-received by meeting attendees. For many radiologists who participated in the various musical and artistic offerings at the AUR 2023 meeting, sharing artistic talents with the radiology community and colleagues represented the most fundamental way to be fully seen, express authenticity, and connect with others.

The Big Squeeze: Factors Contributing to Moral Distress Among Radiologist Clinician-Educators.

Moral distress is a term used to describe the cognitive-emotional dissonance that is experienced when one is compelled to act contrary to one's moral requirements. This occurs as a result of systemic constraints that prevent an individual from taking actions that they perceive as morally right, resulting in a perceived violation of one's core values and duties. There has been a growing interest in the prevalence of moral distress in healthcare, particularly as a root cause of burnout. A recent national survey on moral distress in radiology found that 98% of respondents experienced at least some degree of moral distress with 18% of respondents having left a position due to moral distress. One of the scenarios associated with the highest degree of moral distress related to the conflict that arises when one feels unable to fulfill teaching responsibilities due to high clinical demands. Now more than ever, clinician-educators are asked to do more with less time, fewer resources, and in an increasingly demanding work environment that is often discordant with providing quality education to their learners. In this manuscript, we aim to discuss the factors contributing to moral distress in radiologist clinician-educators as a framework to better understand the implications of these drivers, and to offer our perspective on potential mitigating measures.

American College of Radiology Paid Family/Medical Leave Policy: A Call to Action for the House of Medicine.

The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that "diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed." The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

Meeting Faculty Development Needs: Review of Current Resources and Opportunities for Program Development.

This paper will review faculty development focus and programming at the early, mid and late career stages. Topics covered include challenges at each career stage, institutional and national programming currently available for the needs of faculty at that stage, and suggested best practices for development of new career focus and potential programs for each stage.

Radiology Medical Student Education 2020: Surveys of the Alliance of Medical Student Educators in Radiology and Medical Students.

RATIONALE AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes to medical student education by disrupting clinical rotations, licensing exams, and residency applications. To evaluate the pandemic's impact and required modifications of radiology medical student courses, the authors developed and administered surveys to Alliance of Medical Student Educators in Radiology (AMSER) faculty and enrolled medical students. The surveys requested feedback and insight about respondents' experiences and innovations. MATERIALS AND METHODS: Anonymous twenty-question and seventeen-question surveys about the pandemic's impact on medical student education were distributed via email to AMSER members and medical students. The surveys consisted of multiple choice, ranking, Likert scale, and open-ended questions. Differences in the Likert score agreement was performed using one-sided Wilcoxon-Mann-Whitney tests. Survey data were collected using SurveyMonkey (San Mateo, California). This study was IRB exempt. RESULTS: The AMSER survey indicated 96% of institutions cancelled medical student courses and 92% resumed with virtual courses, typically general radiology. A total of 64% of faculty enjoyed online teaching, although 82% preferred on-site courses. A total of 62% of students felt an online radiology course was an excellent alternative to an on-site rotation, although 27% disagreed. A total of 69% of students who completed both on-site and online courses preferred the on-site format. Survey-reported innovations and free response comments have been collated as educational resources. CONCLUSION: Faculty were able to adapt radiology courses to the online environment utilizing interactive lectures, self-directed learning, flipped classroom sessions, and virtual readouts, which were effective for student respondents. Hybrid rotations with on-site and online elements may offer the best of both worlds.

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.

Self-Care and Storytelling for Radiologists: A Feasibility Study.

RATIONALE AND OBJECTIVES: Physician wellness and burnout mitigation strategies have become priority practices in recent years. Despite these efforts, however, physicians living with the psychological effects of the current COVID-19 global pandemic, political stressors, and social injustices, face ever increasing threats to their personal and professional well-being. This manuscript investigates the process of storytelling as a self-care practice for radiologists. MATERIALS AND METHODS: The AUR Well Being Ad-Hoc Committee introduced and approved Storytelling Geek Week, a virtual workshop held by The Moth, a Peabody award-winning storytelling nonprofit group. Nineteen AUR members applied and were selected for participation in the workshop which occurred over 5 days in November 2020. Anonymous electronic surveys were sent to participants before and after the workshop to gather feedback on their experience. RESULTS: Of the 19 AUR member participants, 12 (63%) completed the pre-workshop survey and 8 (42%) completed the post-workshop survey. Participant current state of well-being was found to be increased between the pre- and post-course surveys, with a statistically significant adjusted P-value of 0.017. All 8 post-workshop respondents reported that they would recommend the workshop to others. With regard to how participation in the workshop impacted their wellbeing, representative free text responses include, "helped with processing emotions," and "felt more connected to strangers." Regarding shifts in perspective as a result of workshop participation, representative free text responses include, "more empathetic" and "started focusing on hope and gratitude rather than sadness and anxiety." CONCLUSION: Participants in a storytelling workshop reported a positive impact on their perceived sense of well-being. Respondents also reports shifts in their sense of empathy and connectedness to others. This type of intervention may help to mitigate burnout and build community during challenging times.

Resident Clinician Educator Leadership Pathway Tracks in US Radiology Programs: An ADVICER 2021 Survey Study.

RATIONALE AND OBJECTIVES: The purpose of this manuscript is to elucidate the prevalence, characteristics, outcomes, and perceptions of Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER) members on Clinician Educator Leadership Pathway (CELP) tracks in diagnostic and interventional radiology residency programs in the United States. MATERIALS AND METHODS: IRB exemption was obtained for this study. A 17-question anonymous survey was administered to the ADVICER members, an Association of University Radiologists (AUR) affiliate group, via email once, and then as a reminder 14 days later. Statistical analysis occurred via built-in analytics of the survey vendor, SurveyMonkey. RESULTS: Thirty five of 72 ADVICER members (48.6%) responded to the survey. 45.7% (16/35) respondents indicated the presence of leadership or specialty pathways in their respective residencies. 28.6% of respondents indicated a CELP (10/35) in their residency programs. 92.0% of respondents endorsed CELP as preparatory for an academic career, and 93.6% endorsed development of a national CELP curriculum. CONCLUSION: The majority of radiology residency programs do not have a CELP in their training curriculum. ADVICER leaders overwhelmingly support CELP for professional development of the future educational leaders in radiology and endorse the creation of a national CELP curriculum.

What is the preferred central venous pressure zero reference for hepatic resection?

BACKGROUND: The common practice of maintaining central venous pressure (CVP) below 5 mm Hg to reduce blood loss during hepatic resection increases the risk of venous air embolism (VAE). We initiated this study after observing that the anteroposterior (AP) diameter of the liver can be much larger than 7 cm, which is the approximate hydrostatic pressure corresponding to a CVP of 5 mm Hg (1 mm Hg = 1.36 cm H(2)O). The purpose of this study was to characterize the liver AP diameter and thereby describe how this might affect the placement of the CVP transducer to balance the risks of bleeding and VAE. METHODS: We measured the AP liver diameter and its distance from other anatomic sites using consecutive archived chest tomograms with IV contrast from 100 adults. RESULTS: The results of our study demonstrate a large interindividual range in AP liver dimensions (17.9 + or - 2.8 cm, range = 12.0-28.5 cm) and standardized anatomic landmarks relative to the portal triad. CONCLUSIONS: The significant variability in AP liver diameter, along with the variability in the liver surgical site, suggests that we rethink the zero reference point for the CVP transducer during hepatic surgeries. By considering the actual hepatic venous pressure itself, rather than the CVP, we can minimize the risks of VAE and hemorrhage. Two methods for zeroing the reference transducer are suggested.

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.

Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant.

BACKGROUND: Sellick described cricoid pressure (CP) as pinching the esophagus between the cricoid ring and the cervical spine. A recent report noted that with the application of CP, the esophagus moved laterally more than 90% of the time, questioning the efficacy of this maneuver. We designed this study to accurately define the anatomy of the Sellick maneuver and to investigate its efficacy. METHODS: Twenty-four nonsedated adult volunteers underwent neck magnetic resonance imaging with and without CP. Measurements were made of the postcricoid hypopharynx, airway compression, and lateral displacement of the cricoid ring during the application of CP. The relevant anatomy was reviewed. RESULTS: The hypopharynx, not the esophagus, is what lies behind the cricoid ring and is compressed by CP. The distal hypopharynx, the portion of the alimentary canal at the cricoid level, was fixed with respect to the cricoid ring and not mobile. With CP, the mean anterioposterior diameter of the hypopharynx was reduced by 35% and the lumen likely obliterated, and this compression was maintained even when the cricoid ring was lateral to the vertebral body. CONCLUSIONS: The location and movement of the esophagus is irrelevant to the efficiency of the Sellick's maneuver (CP) in regard to prevention of gastric regurgitation into the pharynx. The hypopharynx and cricoid ring move together as an anatomic unit. This relationship is essential to the efficacy and reliability of Sellick's maneuver. The magnetic resonance images show that compression of the alimentary tract occurs with midline and lateral displacement of the cricoid cartilage relative to the underlying vertebral body.

The Power of Design Thinking in Medical Education.

A goal of medical education should be to optimize educational experiences of our learners. How can we better understand their experiences and design educational activities that inspire them to learn? Design Thinking is a powerful process that consists of five iterative phases: empathize, define, ideate, prototype, and test. Empathy with the user experience is at the core of Design Thinking. This helps define the right problem so that the right solutions can be developed. In this article, we share our experiences with using Design Thinking in radiology education. As educators, we are constantly learning and innovating. Design Thinking provides a powerful process and a growth mindset to help develop creative solutions as we move forward. We invite you to join us in this discovery quest for innovative solutions in medical education through the Design Thinking process.

Invasive Procedural Versus Diagnostic Imaging and Clinical Services Rendered by Radiology Trainees Over Two Decades.

PURPOSE: To characterize evolving radiology trainee exposure to invasive procedures. METHODS: Using Physician/Supplier Procedure Summary Master Files from 1997 to 2016, we identified Medicare services performed by radiology trainees in approved programs by extracting information on services billed by diagnostic and interventional radiologists reported with "GC" modifiers. Services were categorized as (1) invasive procedures, (2) noninvasive diagnostic imaging services, or (3) clinical evaluation and management (E&M) services. Relative category trainee work effort was estimated using service-level work relative value units. RESULTS: Nationally from 1997 to 2016, invasive procedures declined from 34.2% to 14.3% of relative work effort for all Medicare-billed radiology trainee services. Radiology trainees' noninvasive diagnostic imaging services increased from 65.1% to 85.4%. Clinical E&M services remained uniformly low (0.7%-0.3%). Diagnostic radiology (DR) and interventional radiology (IR) faculty supervised 81.0% and 19.0%, respectively, of all trainee invasive procedures in 1997, versus 68.3% and 31.7%, respectively, in 2016. Despite declining relative procedural work, trainees were exposed to a wide range of both basic and complex invasive procedures in both 1997 and 2016. Over this period, trainee noninvasive diagnostic imaging services shifted away from radiography to CT and MRI. CONCLUSION: Radiology trainees' relative invasive procedural work effort has declined over time as their work increasingly focuses on CT and MRI. As DR and IR-DR residency curricula begin to diverge, it is critical that both DR and IR residents receive robust training in basic image-guided procedures to ensure broad patient access to these services.

Diagnostic Radiology Resident Recruitment Part I: Advice to Programs (and Program Directors) From Vice Chairs for Education.

To the best of our knowledge, there is little available organized advice for diagnostic radiology residency program directors and their programs regarding resident recruitment. We are a group of current and former program directors who are current vice chairs for education and continue to advise and to mentor many educators. We have constructed this article along the yearly schedule of trainee recruitment, including an application review, interviews, and troublesome trends that we have observed.