From Great Resignation to Great Retention: Orientation as a First Step in Engaging Faculty Well-being
Onboarding lays a foundation spanning multipart missions and teaches faculty how to engage and excel in the departmental environment. At the enterprise level, onboarding is a process to connect and support diverse teams, with a range of symbiotic phenotypes, into thriving departmental ecosystems. At the more personal level, onboarding involves guiding individuals with unique backgrounds, experiences, and strengths into their new roles, growing both the individual and the system. This guide will share elements of an initial step in the departmental faculty onboarding process, faculty orientation.
Prevalence of Adenopathy at Chest Computed Tomography After Vaccination for Severe Acute Respiratory Syndrome Coronavirus 2
OBJECTIVE:This study aimed to determine the prevalence of axillary and subpectoral (SP) lymph nodes after ipsilateral COVID-19 vaccine administration on chest computed tomography (CT). METHODS:Subjects with chest CTs between 2 and 25 days after a first or second vaccine dose, December 15, 2020, to February 12, 2021, were included. Orthogonal measures of the largest axillary and SP nodes were recorded by 2 readers blinded to vaccine administration and clinical details. A mean nodal diameter discrepancy of ≥6 mm between contralateral stations was considered positive for asymmetry. Correlation with the side of vaccination, using a Spearman rank correlation, was performed on the full cohort and after excluding patients with diseases associated with adenopathy. RESULTS:Of the 138 subjects (81 women, 57 men; mean [SD] age, 74.4 ± 11.7 years), 48 (35%) had asymmetrically enlarged axillary and/or SP lymph nodes, 42 (30%) had ipsilateral, and 6 (4%) had contralateral to vaccination ( P = 0.003). Exclusion of 29 subjects with conditions associated with adenopathy showed almost identical correlation, with asymmetric nodes in 32 of 109 (29%) ipsilateral and in 5 of 109 (5%) contralateral to vaccination ( P = 0.002). CONCLUSIONS:Axillary and/or SP lymph nodes ipsilateral to vaccine administration represents a clinical conundrum. Asymmetric nodes were detected at CT in 30% of subjects overall and 29% of subjects without conditions associated with adenopathy, approximately double the prevalence rate reported to the Centers for Disease Control and Prevention by vaccine manufacturers. When interpreting examinations correlation with vaccine administration timing and site is important for pragmatic management.
Mentoring Underrepresented Minority Physician-Scientists to Success
As the nation seeks to recruit and retain physician-scientists, gaps remain in understanding and addressing mitigatable challenges to the success of faculty from underrepresented minority (URM) backgrounds. The Doris Duke Charitable Foundation Fund to Retain Clinical Scientists program, implemented in 2015 at 10 academic medical centers in the United States, seeks to retain physician-scientists at risk of leaving science because of periods of extraordinary family caregiving needs, hardships that URM faculty-especially those who identify as female-are more likely to experience. At the annual Fund to Retain Clinical Scientists program directors conference in 2018, program directors-21% of whom identify as URM individuals and 13% as male-addressed issues that affect URM physician-scientists in particular. Key issues that threaten the retention of URM physician-scientists were identified through focused literature reviews; institutional environmental scans; and structured small- and large-group discussions with program directors, staff, and participants. These issues include bias and discrimination, personal wealth differential, the minority tax (i.e., service burdens placed on URM faculty who represent URM perspectives on committees and at conferences), lack of mentorship training, intersectionality and isolation, concerns about confirming stereotypes, and institutional-level factors. The authors present recommendations for how to create an environment in which URM physician-scientists can expect equitable opportunities to thrive, as institutions demonstrate proactive allyship and remove structural barriers to success. Recommendations include providing universal training to reduce interpersonal bias and discrimination, addressing the consequences of the personal wealth gap through financial counseling and benefits, measuring the service faculty members provide to the institution as advocates for URM faculty issues and compensating them appropriately, supporting URM faculty who wish to engage in national leadership programs, and sustaining institutional policies that address structural and interpersonal barriers to inclusive excellence.
Medical Student Engagement and Educational Value of a Remote Clinical Radiology Learning Environment: Creation of Virtual Read-Out Sessions in Response to the COVID-19 Pandemic
RATIONALE AND OBJECTIVES/OBJECTIVE:The need for social distancing has resulted in rapid restructuring of medical student education in radiology. While students traditionally spend time learning in the reading room, remote clinical learning requires material shared without direct teaching at the radiology workstation. Can remote clinical learning meet or exceed the educational value of the traditional in-person learning experience? Can student engagement be matched or exceeded in a remote learning environment? MATERIALS AND METHODS/METHODS:To replace the in-person reading room experience, a small-group learning session for medical students named Virtual Read-Out (VRO) was developed using teleconferencing software. After Institutional Review Board approval, two student groups were anonymously surveyed to assess differences in student engagement and perceived value between learning environments: "Conventional" students participating in the reading room (before the pandemic) and "Remote" students participating in VRO sessions. Students reported perceived frequency of a series of five-point Likert statements. Based on number of respondents, an independent t-test was performed to determine the significance of results between two groups. RESULTS:Twenty-seven conventional and 41 remote students responded. Remote students reported modest but significantly higher frequency of active participation in reviewing radiology exams (p < 0.05). There was significantly lower frequency of reported boredom among Remote students (p < 0.05). There was no significant difference in perceived educational value between the two groups. CONCLUSION/CONCLUSIONS:Students report a high degree of teaching quality, clinical relevance, and educational value regardless of remote or in-person learning format. Remote clinical radiology education can be achieved with equal or greater student interaction and perceived value in fewer contact hours than conventional learning in the reading room.
Pulmonary Embolism at CT Pulmonary Angiography in Patients with COVID-19
Purpose/UNASSIGNED:To evaluate pulmonary embolism (PE) prevalence at CT pulmonary angiography in patients testing positive for coronavirus disease 2019 (COVID-19) and factors associated with PE severity. Materials and Methods/UNASSIGNED:value < .05 was considered significant. Results/UNASSIGNED:< .001). One additional patient with negative results at CT pulmonary angiography had deep venous thrombosis, thus resulting in 38.7% with PE or deep venous thrombosis, despite 40% receiving prophylactic anticoagulation. Other factors did not demonstrate significant PE association. Conclusion/UNASSIGNED:Â© RSNA, 2020.
High Incidence of Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation
Background We observed a high number of patients with COVID-19 pneumonia who had barotrauma related to invasive mechanical ventilation at our institution. Purpose To determine if the rate of barotrauma in patients with COVID-19 infection was greater than other patients requiring invasive mechanical ventilation at our institution. Methods In this retrospective study, clinical and imaging data of patients seen between 03/01/2020 and 04/06/2020 who tested positive for COVID-19 and experienced barotrauma associated with invasive mechanical ventilation were compared to patients without COVID-19 infection during the same period. Historical comparison was made to barotrauma rates of patients with acute respiratory distress syndrome (ARDS) from 02/01/2016 to 02/01/2020 at our institution. Comparison of patient groups was performed using categorical or continuous statistical testing as appropriate with multivariable regression analysis. Patient survival was assessed using Kaplan-Meier curves analysis. Results 601 patients with COVID-19 infection underwent invasive mechanical ventilation (63 Â± 15 years, 71% men). There were 89/601 (15%) patients with one or more barotrauma events, for a total of 145 barotrauma events (24% overall events) (95% CI 21-28%). During the same period, 196 patients without COVID-19 infection (64 Â± 19 years, 52% male) with invasive mechanical ventilation had 1 barotrauma event (.5% 95% CI, 0-3%, p<.001 vs. the group with COVID-19 infection). Of 285 patients with ARDS over the prior 4 years on invasive mechanical ventilation (68 Â± 17 years, 60% men), 28 patients (10%) had 31 barotrauma events, with overall barotrauma rate of 11% (95% CI 8-15%, p<.001 vs. the group with COVID-19 infection). Barotrauma is an independent risk factor for death in COVID-19 (OR=2.2, p=.03), and is associated with longer hospital length of stay (OR=.92, p<.001). Conclusion Patients with COVID-19 infection and invasive mechanical ventilation had a higher rate of barotrauma than patients with ARDS and patients without COVID-19 infection.
CT screening for lung cancer: comparison of three baseline screening protocols
Incidentally Detected Mediastinal Mass on a Chest Radiograph
Developing a Job Description for a Vice Chair of Education in Radiology: The ADVICER Template
RATIONALE AND OBJECTIVES: The newly formed Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER), a group within the Alliance for Clinician Educators in Radiology, identified an acute need for a generic job description template for Vice Chairs of Education in Radiology, a role that is being developed in many academic Departments of Radiology. Eighty-three percent of current members who responded to a survey had no detailed job description, and over half had no job description at all. Having a comprehensive and detailed job description is vital to developing this key position. MATERIALS AND METHODS: Using the results of a survey sent to ADVICER members and seven Education Vice Chair job descriptions provided by members, the authors developed a detailed job description encompassing all potential elements of this position. RESULTS: Only 17% of survey respondents had a detailed job description. The role of an Education Vice Chair varies significantly between institutions in its scope and level of responsibilities. The resultant generic job description that was devised is intended to provide a template that would be modified by the candidate or the Department Chair. It is unlikely that any one individual would perform all the described activities. CONCLUSIONS: ADVICER has developed a comprehensive, flexible job description for Vice Chair of Education in Radiology that can be adapted by institutions as appropriate. It can be downloaded from http://aur.org/ADVICER/.
Radiation therapy for stage I lung cancer detected on computed tomography screening: Results from the international early lung cancer action program
Objective: The International Early Lung Cancer Action Program (I-ELCAP) is a collaborative group designed to demonstrate reduction in lung cancer mortality by using low-dose computed tomography (CT) screening to identify early stage disease in high-risk individuals. While the majority of patients with stage I non-small cell lung cancer (NSCLC) were treated with surgical resection, some patients were treated with definitive radiation. This study explores the characteristics and outcomes of this population. Methods: Clinical stage I NSCLC patients in North America treated by radiotherapy or surgery alone were identified in the I-ELCAP database. All had undergone low-dose CT screening according to a common protocol from 1993 to 2009. Patient characteristics and lung cancer-specific Kaplan-Meier survival rates were compared. Results: From 32,521 baseline and 34,394 annual repeat screenings, 455 cases of clinical stage I NSCLC were identified. Only 12 of these patients (2.6 %) underwent definitive radiation with median follow-up of 5.3 years. These 12 patients when compared with the 376 patients treated by surgery alone were older (72 vs. 67 years, p = 0.01), had more pre-existing comorbidities (1.5 vs. 1.0, p = 0.005), but had no significant differences in male gender, pack-years of smoking, emphysema, or tumor size. The median radiation dose was 6,150 cGy. There was no difference in lung cancer-specific survival between surgery and radiation (92 vs. 90 %, p = 0.78). Conclusion: This is the first study to show outcomes of definitive radiation for stage I NSCLC in a screened population. Although only used in a small number of cases, there is no difference in lung cancer-specific survival when comparing definitive radiation to surgical resection. 2014 Springer-Verlag Berlin Heidelberg