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National survey to assess gender, racial, and ethnic differences among radiology residency applicants regarding factors impacting program selection

Madsen, Laura B; Kalantarova, Sofya; Jindal, Ragni; Akerman, Meredith; Fefferman, Nancy R; Hoffmann, Jason C
RATIONAL AND OBJECTIVES/OBJECTIVE:Radiology has one of the lowest female representation rates in medicine and recruiting female residents is a challenge for some residency programs. There is limited understanding of gender differences among residency applicants during program selection. The study objective is to investigate which program factors were considered most important by radiology residency applicants and to assess for differences by gender, race and ethnicity. MATERIALS AND METHODS/METHODS:An anonymous survey was distributed electronically to diagnostic and interventional radiology residency programs in the US and Canada via the Association of Program Coordinators in Radiology (APCR). Residents were asked to evaluate the importance of 30 factors during evaluation of residency programs using a 5-point Likert scale (1 = not important, 5 = extremely important). RESULTS:370 residents and 1 fellow completed the survey. Of the respondents, 269 were male (72.5%) and 101 were female (27.2%). The most important factors to respondents during program selection were program culture (4.42), geographic location (4.17), fellowship placement (4.14), and imaging and/or procedure volume (3.98). There was a significant difference between male and female respondents in the importance of program culture (p = 0.002), composition of current residents (p = 0.007), percentage of current female residents (p < 0.0001), program size (p = 0.047), call schedule (p = 0.025), percentage of female faculty (p < 0.0001), faculty ethnic and racial diversity (p < 0.0001), resident ethnic and racial diversity (p < 0.0001), which female respondents ranked more highly. CONCLUSION/CONCLUSIONS:Applicants consider many factors during residency program selection. Program culture, geographic location, fellowship placement and imaging and/or procedural volume were most important. There were significant differences by gender, race and ethnicity in importance of several factors.
PMID: 32811713
ISSN: 1878-4046
CID: 4566862

Incorporation of a Social Virtual Reality Platform into the Residency Recruitment Season

Guichet, Phillip L; Huang, Jeffrey; Zhan, Chenyang; Millet, Alexandra; Kulkarni, Kopal; Chhor, Chloe; Mercado, Cecilia; Fefferman, Nancy
RATIONALE AND OBJECTIVES/OBJECTIVE:The Covid-19 pandemic ushered a sudden need for residency programs to develop innovative socially distant and remote approaches to effectively promote their program. Here we describe our experience using the social virtual reality (VR) platform Mozilla Hubs for the pre-interview social during the 2020-2021 radiology residency virtual recruitment season, provide results of a survey sent to assess applicants' attitudes towards the VR pre-interview social, and outline additional use-cases for the emerging technology. MATERIALS AND METHODS/METHODS:A VR Meeting Hall dedicated to the pre-interview social was designed in Mozilla Hubs. To assess applicants' impressions of the Mozilla Hubs pre-interview social, applicants were sent an optional web-based survey. Survey respondents were asked to respond to a series of eleven statements using a five-point Likert scale of perceived agreement: Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree. Statements were designed to gauge applicants' attitudes towards the Mozilla Hubs pre-interview social and its usefulness in helping them learn about the residency program, particularly in comparison with pre-interview socials held on conventional video conferencing software (CVCS). RESULTS:Of the 120 residency applicants invited to the Mozilla Hubs pre-interview social, 111 (93%) attended. Of these, 68 (61%) participated in the anonymous survey. Most applicants reported a better overall experience with Mozilla Hubs compared to CVCS (47/68, 69%), with 10% (7/68) reporting a worse overall experience, and 21% (14/68) neutral. Most applicants reported the Mozilla Hubs pre-interview social allowed them to better assess residency culture than did pre-interview socials using CVCS (41/68, 60%). Seventy-two percent of applicants reported that the Mozilla Hubs pre-interview social positively impacted their decision to strongly consider the residency program (49/68). CONCLUSION/CONCLUSIONS:Radiology residency applicants overall preferred a pre-interview social hosted on a social VR platform, Mozilla Hubs, compared to those hosted on CVCS. Applicants reported the use of a social VR platform reflected positively on the residency and positively impacted their decision to strongly consider the program.
PMID: 34217613
ISSN: 1878-4046
CID: 4965632

A think-aloud study to inform the design of radiograph interpretation practice

Yoon, Jong-Sung; Boutis, Kathy; Pecaric, Martin R; Fefferman, Nancy R; Ericsson, K Anders; Pusic, Martin V
Models for diagnostic reasoning in radiology have been based on the observed behaviors of experienced radiologists but have not directly focused on the thought processes of novices as they improve their accuracy of image interpretation. By collecting think-aloud verbal reports, the current study was designed to investigate differences in specific thought processes between medical students (novices) as they learn and radiologists (experts), so that we can better design future instructional environments. Seven medical students and four physicians with radiology training were asked to interpret and diagnose pediatric elbow radiographs where fracture is suspected. After reporting their diagnosis of a case, they were given immediate feedback. Participants were asked to verbalize their thoughts while completing the diagnosis and while they reflected on the provided feedback. The protocol analysis of their verbalizations showed that participants used some combination of four processes to interpret the case: gestalt interpretation, purposeful search, rule application, and reasoning from a prior case. All types of processes except reasoning from a prior case were applied significantly more frequently by experts. Further, gestalt interpretation was used with higher frequency in abnormal cases while purposeful search was used more often for normal cases. Our assessment of processes could help guide the design of instructional environments with well-curated image banks and analytics to facilitate the novice's journey to expertise in image interpretation.
PMID: 32140874
ISSN: 1573-1677
CID: 4339982

Preserving Radiology Resident Education During the COVID-19 Pandemic: The Simulated Daily Readout

Recht, Michael P; Fefferman, Nancy R; Bittman, Mark E; Dane, Bari; Fritz, Jan; Hoffmann, Jason C; Hood, Joseph; Mercado, Cecilia L; Mahajan, Sonia; Sheth, Monica M
RATIONALE AND OBJECTIVES/OBJECTIVE:The educational value of the daily resident readout, a vital component of resident training, has been markedly diminished due to a significant decrease in imaging volume and case mix diversity. The goal of this study was to create a "simulated" daily readout (SDR) to restore the educational value of the daily readout. MATERIALS AND METHODS/METHODS:To create the SDR the following tasks were performed; selection of cases for a daily worklist for each resident rotation, comprising a combination of normal and abnormal cases; determination of the correct number of cases and the appropriate mix of imaging modalities for each worklist; development of an "educational" environment consisting of separate "instances" of both our Picture Archive Communication System and reporting systems; and the anonymization of all of the cases on the worklists. Surveys of both residents and faculty involved in the SDR were performed to assess its effectiveness. RESULTS:Thirty-two residents participated in the SDR. The daily worklists for the first 20 days of the SDR included 3682 cases. An average of 480 cases per day was dictated by the residents. Surveys of the residents and the faculty involved in the SDR demonstrated that both agreed that the SDR effectively mimics a resident's daily work on rotations and preserves resident education during the Coronavirus Disease 2019 crisis. CONCLUSION/CONCLUSIONS:The development of the SDR provided an effective method of preserving the educational value of the daily readout experience of radiology residents, despite severe decreases in imaging exam volume and case mix diversity during the Coronavirus Disease 2019 pandemic.
PMID: 32553278
ISSN: 1878-4046
CID: 4484992

Assessing the impact of an orientation week on acclimation to radiology residency

Prabhu, Vinay; Rispoli, Joanne M; Chhor, Chloe M; Mercado, Cecilia L; Fefferman, Nancy R
PURPOSE/OBJECTIVE:Acclimating residents to radiology residency requires attention to new responsibilities, educational material, and social cohesion. To this end, we instituted a structured orientation week for incoming residents and assessed its impact. PROCEDURES/METHODS:During the first weeks of July 2016 and 2017, first year residents attended a five day orientation free of clinical duties, consisting of didactics, hands-on training sessions, and social events. After two orientation cohorts, residents who completed orientation week, and two cohorts who had not, were given a voluntary, anonymous survey using Likert scale questions (1 [worst] to 5 [best]) regarding preparedness for responsibilities, learning, and social cohesion. Residents were asked which components were or would have been helpful. Independent samples t-tests were performed to evaluate differences between the two groups (two-tailed p < 0.05). FINDINGS/RESULTS:21/37 (57%) residents participated. Higher percentages of residents who participated in the orientation week gave scores ≥4 when asked about preparedness for rotations (70% vs. 36%), learning new material (80% vs. 36%), and class cohesiveness (90% vs. 70%). Mean scores on these questions were also higher for these residents with regards to: preparedness for new responsibilities (3.7 vs. 2.9), learning new material (3.8 vs. 2.9), and class cohesiveness (4.5 vs. 3.8), with differences approaching significance (p = 0.09-0.15). Individual components receiving most votes of ≥4 were social outings, resident lunches, didactic lectures, and PACS training. CONCLUSION/CONCLUSIONS:A weeklong orientation program free of clinical duties was valued by residents and contributed to acclimation to new responsibilities, education, and social cohesion.
PMID: 32387799
ISSN: 1873-4499
CID: 4430812

Developing an Education Budget for Radiology Vice Chairs and Leaders: An ADVICER Template

Fefferman, Nancy R; Jordan, Sheryl G; Slanetz, Priscilla J; Morgan, Desiree E; Gordon, Leonie L; Suh, Robert D; Mullins, Mark E
RATIONALE AND OBJECTIVES/OBJECTIVE:The Alliance of Directors and Vice Chairs in Education group identified the need to develop an education budget template as resource for our community. Having a framework and working knowledge of budgetary considerations is crucial to those with general oversight and executive managerial responsibility for departmental educational programs. METHODS:An online survey was sent to all the Alliance of Directors and Vice Chairs in Education members. Survey questions included education funding sources, presence of vice chair of finance, expectation of revenue generation, existing education budget, funding decision-makers, education budget formulation and approval, vice chair of education's role in budget, education budget line items, and income statement review. RESULTS:The survey response rate was 41/81 (51%). A majority 26/41 (63%) of respondents had an education budget that typically included funding for all medical students, residents, and fellows but only a minority of respondents report they developed 10/22 (45%), approved 6/22 (27%), or regularly reviewed 6/21 (29%) this budget. In sharp contrast was the role of department chairs and administrators, who presumably all participated in this process. To assist in education budget development and review, as well as meet the need to improve participants' financial accounting knowledge as a key tenet of faculty professional development, the authors developed sample budget templates and an income statement primer. CONCLUSION/CONCLUSIONS:Our survey results suggested the need for an educational budget framework and financial accounting resources for those in radiology education posts, and resources have been provided.
PMID: 31171464
ISSN: 1878-4046
CID: 3918232

Visualization of the normal appendix in children: feasibility of a single contrast-enhanced radial gradient recalled echo MRI sequence

Lala, Shailee V; Strubel, Naomi; Nocera, Nicole; Bittman, Mark E; Fefferman, Nancy R
BACKGROUND:Magnetic resonance imaging (MRI) assessment for appendicitis is limited by exam time and patient cooperation. The radially sampled 3-dimensional (3-D) T1-weighted, gradient recalled echo sequence (radial GRE) is a free-breathing, motion robust sequence that may be useful in evaluating appendicitis in children. OBJECTIVE:To compare the rate of detection of the normal appendix with contrast-enhanced radial GRE versus contrast-enhanced 3-D GRE and a multi-sequence study including contrast-enhanced radial GRE. MATERIALS AND METHODS/METHODS:This was a retrospective study of patients ages 7-18 years undergoing abdominal-pelvic contrast-enhanced MRI between Jan. 1, 2012, and April 1, 2016. Visualization of the appendix was assessed by consensus between two pediatric radiologists. The rate of detection of the appendix for each sequence and combination of sequences was compared using a McNemar test. RESULTS:The rate of detection of the normal appendix on contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (76% vs. 57.3%, P=0.003). The rate of detection of the normal appendix with multi-sequence MRI including contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (81.3% vs. 57%, P<0.001). There was no significant difference between the rate of detection of the normal appendix on contrast-enhanced radial GRE alone and multi-sequence MRI including contrast-enhanced radial GRE (76% vs. 81.3%, P=0.267). CONCLUSION/CONCLUSIONS:Contrast-enhanced radial GRE allows superior detection of the normal appendix compared to contrast-enhanced 3-D GRE. The rate of detection of the normal appendix on contrast-enhanced radial GRE alone is nearly as good as when the contrast-enhanced radial GRE is interpreted with additional sequences.
PMID: 30783687
ISSN: 1432-1998
CID: 3686192

Reply to Letter to the Editor [Letter]

Tomita, Sandra; Fisher, Jason C; Fefferman, Nancy; Ginsburg, Howard B; Kuenzler, Keith A; Choi, Beatrix Hyemin
PMID: 30612745
ISSN: 1531-5037
CID: 3579772

Multi-institutional implementation of an automated tool to predict pediatric skeletal bone age: How we did it [Meeting Abstract]

Khandwala, N; Eng, D; Milla, S S; Kadom, N; Strubel, N; Lala, S; Fefferman, N; Filice, R; Prabhu, S P; Francavilla, M L; Kaplan, S; Sharp, S E; Towbin, A J; Everist, M; Irani, N; Halabi, S
Purpose or Case Report: Skeletal bone age assessment is a common clinical practice to investigate endocrinology, genetic and growth disorders of children. Clinical interpretation and bone age analyses are time-consuming, labor intensive and often subject to inter-observer variability. Bone age prediction models developed with deep learning methodologies can be leveraged to automate bone age interpretation and reporting. The bone age model developed at our institution was offered to interested health systems and institutions to implement and validate the model. This study discusses the logistical, technical, and clinical issues encountered with this model implementation. Methods & Materials: After IRB approval, multiple U.S. based radiology departments were solicited to adopt and validate the Stanford University bone age model. A total of 8 institutions (4 standalone pediatric hospitals and 4 academic radiology departments) agreed to partner with the primary investigators. IRBs at each institution were required in addition to registration with registry. Standardization of the data use agreements was performed. Patient data and protected health information data was retained at each institution. Technical requirements included model hosting at each institution and integration to send images to the model server and results to the interpreting radiologists.
Result(s): Multiple logistical, technical, and clinical issues were encountered. IRBs at the various institutions had different requirements including waiving patient consent. Technical differences between institutions included model hosting, PACS integrations, interfaces with the reporting system, and image preprocessing. Clinical differences included report templates, calculation of bone age standard deviation, use of Brush foundation, and ability to directly send bone predictions to the reporting system (versus displaying the results as a separate interface). The bone age model was successfully implemented at 7 institutions and approximately 190 studies have been evaluated.
Conclusion(s): There are myriad challenges to implementing and validating models developed with deep learning methodologies. As models are developed for various clinical use cases including bone age assessment, it will be incumbent on radiology practices and health information systems to integrate these models into clinical practice
ISSN: 1432-1998
CID: 3831612

Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line placement in children

Choi, Beatrix Hyemin; Yaya, Kamalou; Prabhu, Vinay; Fefferman, Nancy; Mitchell, Beverly; Kuenzler, Keith A; Ginsburg, Howard B; Fisher, Jason C; Tomita, Sandra
PURPOSE/OBJECTIVE:The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job-instruction model with a preradiation time-out. METHODS:We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22 months before the intervention through 10 months after 2013-2016. The intervention consisted of a radiation safety briefing by the surgeon to the intraoperative staff before each case and a radiation safety time-out. We measured and analyzed the dose area product (DAP), total radiation time pre- and postintervention, and the use of postprocedural chest radiograph. RESULTS:, P < 0.001) and a 73% decrease in the median radiation time (28 vs 7.6 s, P < 0.001). Additionally, there was a significant reduction in use of confirmatory CXR (95% vs 15%, P < 0.01). CONCLUSION/CONCLUSIONS:A preoperative radiation safety briefing and a radiation safety time-out supported by a job-instruction model were effective in significantly lowering the absorbed doses of radiation in children undergoing CVL insertion. TYPE OF STUDY/METHODS:Case-control study. LEVEL OF EVIDENCE/METHODS:Level III.
PMID: 30415958
ISSN: 1531-5037
CID: 3456542