Radiologic Education
Results of the 2014 Survey of the American Alliance of Academic Chief Residents in Radiology Anup Shetty, MD, Mark Hammer, MD, Jennifer Gould, MD, Ronald Evens, MD Rationale and Objectives: The American Alliance of Academic Chief Residents in Radiology (A3CR2) conducts an annual survey of chief residents in accredited radiology programs in North America. The survey serves as a tool for observing trends and disseminating ideas among radiology programs. Materials and Methods: An online survey conducted through the SurveyMonkey Web site was distributed to chief residents from 187 Accreditation Council on Graduate Medical Education (ACGME)–accredited radiology training programs. A variety of multiple-choice and free-response questions were designed to gather information about residency program details, benefits, chief resident responsibilities, call, preparations for the recent American Board of Radiology Core Examination, implementation of selectives (mini-fellowships), fellowships, health care economics and the job market, and ACGME milestones. Results: Among those surveyed, 212 unique responses from 136 programs were provided, yielding a 73% response rate. Data were compared to historical data from prior surveys dating back through 2002. Conclusions: Programs are increasingly providing 24-hour sonographer coverage, full day routine services on weekends, and 24-hour attending radiologist coverage. The new American Board of Radiology examination format and schedule has driven many changes, including when chief residents serve, board preparation and review, and how the final year of residency training is structured. Despite facing many changes, there is slightly more optimism among chief residents regarding their future job prospects. Key Words: 2014 Radiology Chief Resident Survey. ªAUR, 2014
T
he American Alliance of Academic Chief Residents in Radiology (A3CR2) is an affinity organization of the Association of University Radiologists (AUR) with the purpose of providing a forum for radiology chief residents to exchange ideas, address shared challenges, and develop leadership skills. A survey of chief resident members of A3CR2 is conducted every spring before the annual AUR meeting, with data presented at the conference and subsequently made available online via the A3CR2 Web site (1–12). The survey has been administered every year since 1971, with maintenance of survey data at the Mallinckrodt Institute of Radiology. The survey is designed to gather and share data about how radiology residency programs function, identify trends, and address issues that the programs face. Chief residents look forward to learning about the results at the AUR meeting each spring and taking the information back to their programs to effect change. Residency programs and program
Acad Radiol 2014; 21:1331–1347 From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110. Received April 3, 2014; accepted May 13, 2014. Address correspondence to: A.S. e-mail: [email protected] ªAUR, 2014 http://dx.doi.org/10.1016/j.acra.2014.05.010
directors may use this data to compare themselves with peer institutions and guide residency policy making and budgetary decisions. Survey questions are formulated by chief residents at the Mallinckrodt Institute of Radiology, with input from faculty and program directors along with the steering committee and faculty advisors of A3CR2. MATERIALS AND METHODS In February 2014, an anonymous electronic survey using SurveyMonkey (Palo Alto, CA) was distributed via e-mail to members of A3CR2. Responses were gathered over a 4-week period, with reminder e-mails distributed through the same e-mail list and via the Association of Program Directors in Radiology (APDR) and Association of Program Coordinators in Radiology (APCR) 2 and 3 weeks after the start of the survey period. Individual anonymity was guaranteed by survey design, but respondents were asked to provide their program name to identify responses from multiple chief residents within a single program. Such responses were composited to maximize accuracy of factual data as appropriate but otherwise were included individually for opinion-based questions. Data were exported to Microsoft Excel for analysis. Statistical significance for differences in proportions was determined using a two-tailed Fisher exact probability test 1331
SHETTY ET AL
[Freeman–Halton extension for more than two subgroup analysis (13)], and data for subgroup analysis were compared to the oldest available full data set from 2011 using the Fisher exact test. The analysis of variance test was used for analysis of continuous variables. RESULTS Over the 4-week response period, 212 responses were received from 136 individual programs, representing 73% of training programs. Compared to the previous survey in 2013, overall responses increased by 58% (212 vs. 134), and program representation increased by 27% (136 vs. 99). For the purposes of this survey, residency programs were categorized into three sizes: ‘‘small’’ (fewer than five residents per year, or 31%), ‘‘medium’’ (between five and eight residents per year, or 37%), and ‘‘large’’ (more than eight residents per year, or 32%). Programs were also subdivided by affiliation (community [38%] vs. university based [62%]) and setting (rural [21%] vs. urban [79%]). Programs were also categorized into four geographic regions: northeast, south, midwest, and west, according to the US Census Bureau statistical regions (http://www.census.gov/ geo/maps-data/maps/pdfs/reference/us_regdiv.pdf). Program Information
Radiology training programs were assessed in terms of size, demographics, volume, moonlighting opportunities, and use of informatics tools. The average size of programs in 2014 is 27 residents, increased from 21 residents in 2003. Although the average number of female residents per program (seven) has increased 35% over the same time span, the distribution of male and female residents remains largely unchanged, with women representing only 26% of all residents. There was no statistically significant difference in proportions of woman residents between program subgroups (ie, size, affiliation, or setting). Our data results correlate with the most recent Accreditation Council on Graduate Medical Education (ACGME) data for 2012–2013 reporting that 27.8% of residents in diagnostic radiology are women (14) and the Association of American Medical Colleges data from 2011 reporting that 24.5% of diagnostic radiology resident are women (15). Programs are covering an increasing number of hospitals, an average of 2.61 in 2014 compared to 2.23 in 2005. Fifteen percent of programs cover five or more hospitals, 11% cover four hospitals, 19% cover three hospitals, 27% cover two hospitals, and 26% cover one hospital. Programs also report an overall greater volume of radiologic studies interpreted each year, as summarized in Table 1. Based on the survey, 77% of programs are affiliated with American Trauma Society–designated level I trauma centers, 85% are affiliated with a National Institutes of Health (NIH)designated stroke center, 50% are affiliated with an NIHdesignated cancer center, and 51% cover a separate pediatric emergency department. 1332
Academic Radiology, Vol 21, No 10, October 2014
TABLE 1. Volume of Studies Read Annually. Proportion of Programs Volume of Studies >750,000 500,000–750,000 250,000–500,000 100,000–250,000
Results of the 2014 Survey of the American Alliance of Academic Chief Residents in Radiology Anup Shetty, MD, Mark Hammer, MD, Jennifer Gould, MD, Ronald Evens, MD Rationale and Objectives: The American Alliance of Academic Chief Residents in Radiology (A3CR2) conducts an annual survey of chief residents in accredited radiology programs in North America. The survey serves as a tool for observing trends and disseminating ideas among radiology programs. Materials and Methods: An online survey conducted through the SurveyMonkey Web site was distributed to chief residents from 187 Accreditation Council on Graduate Medical Education (ACGME)–accredited radiology training programs. A variety of multiple-choice and free-response questions were designed to gather information about residency program details, benefits, chief resident responsibilities, call, preparations for the recent American Board of Radiology Core Examination, implementation of selectives (mini-fellowships), fellowships, health care economics and the job market, and ACGME milestones. Results: Among those surveyed, 212 unique responses from 136 programs were provided, yielding a 73% response rate. Data were compared to historical data from prior surveys dating back through 2002. Conclusions: Programs are increasingly providing 24-hour sonographer coverage, full day routine services on weekends, and 24-hour attending radiologist coverage. The new American Board of Radiology examination format and schedule has driven many changes, including when chief residents serve, board preparation and review, and how the final year of residency training is structured. Despite facing many changes, there is slightly more optimism among chief residents regarding their future job prospects. Key Words: 2014 Radiology Chief Resident Survey. ªAUR, 2014
T
he American Alliance of Academic Chief Residents in Radiology (A3CR2) is an affinity organization of the Association of University Radiologists (AUR) with the purpose of providing a forum for radiology chief residents to exchange ideas, address shared challenges, and develop leadership skills. A survey of chief resident members of A3CR2 is conducted every spring before the annual AUR meeting, with data presented at the conference and subsequently made available online via the A3CR2 Web site (1–12). The survey has been administered every year since 1971, with maintenance of survey data at the Mallinckrodt Institute of Radiology. The survey is designed to gather and share data about how radiology residency programs function, identify trends, and address issues that the programs face. Chief residents look forward to learning about the results at the AUR meeting each spring and taking the information back to their programs to effect change. Residency programs and program
Acad Radiol 2014; 21:1331–1347 From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110. Received April 3, 2014; accepted May 13, 2014. Address correspondence to: A.S. e-mail: [email protected] ªAUR, 2014 http://dx.doi.org/10.1016/j.acra.2014.05.010
directors may use this data to compare themselves with peer institutions and guide residency policy making and budgetary decisions. Survey questions are formulated by chief residents at the Mallinckrodt Institute of Radiology, with input from faculty and program directors along with the steering committee and faculty advisors of A3CR2. MATERIALS AND METHODS In February 2014, an anonymous electronic survey using SurveyMonkey (Palo Alto, CA) was distributed via e-mail to members of A3CR2. Responses were gathered over a 4-week period, with reminder e-mails distributed through the same e-mail list and via the Association of Program Directors in Radiology (APDR) and Association of Program Coordinators in Radiology (APCR) 2 and 3 weeks after the start of the survey period. Individual anonymity was guaranteed by survey design, but respondents were asked to provide their program name to identify responses from multiple chief residents within a single program. Such responses were composited to maximize accuracy of factual data as appropriate but otherwise were included individually for opinion-based questions. Data were exported to Microsoft Excel for analysis. Statistical significance for differences in proportions was determined using a two-tailed Fisher exact probability test 1331
SHETTY ET AL
[Freeman–Halton extension for more than two subgroup analysis (13)], and data for subgroup analysis were compared to the oldest available full data set from 2011 using the Fisher exact test. The analysis of variance test was used for analysis of continuous variables. RESULTS Over the 4-week response period, 212 responses were received from 136 individual programs, representing 73% of training programs. Compared to the previous survey in 2013, overall responses increased by 58% (212 vs. 134), and program representation increased by 27% (136 vs. 99). For the purposes of this survey, residency programs were categorized into three sizes: ‘‘small’’ (fewer than five residents per year, or 31%), ‘‘medium’’ (between five and eight residents per year, or 37%), and ‘‘large’’ (more than eight residents per year, or 32%). Programs were also subdivided by affiliation (community [38%] vs. university based [62%]) and setting (rural [21%] vs. urban [79%]). Programs were also categorized into four geographic regions: northeast, south, midwest, and west, according to the US Census Bureau statistical regions (http://www.census.gov/ geo/maps-data/maps/pdfs/reference/us_regdiv.pdf). Program Information
Radiology training programs were assessed in terms of size, demographics, volume, moonlighting opportunities, and use of informatics tools. The average size of programs in 2014 is 27 residents, increased from 21 residents in 2003. Although the average number of female residents per program (seven) has increased 35% over the same time span, the distribution of male and female residents remains largely unchanged, with women representing only 26% of all residents. There was no statistically significant difference in proportions of woman residents between program subgroups (ie, size, affiliation, or setting). Our data results correlate with the most recent Accreditation Council on Graduate Medical Education (ACGME) data for 2012–2013 reporting that 27.8% of residents in diagnostic radiology are women (14) and the Association of American Medical Colleges data from 2011 reporting that 24.5% of diagnostic radiology resident are women (15). Programs are covering an increasing number of hospitals, an average of 2.61 in 2014 compared to 2.23 in 2005. Fifteen percent of programs cover five or more hospitals, 11% cover four hospitals, 19% cover three hospitals, 27% cover two hospitals, and 26% cover one hospital. Programs also report an overall greater volume of radiologic studies interpreted each year, as summarized in Table 1. Based on the survey, 77% of programs are affiliated with American Trauma Society–designated level I trauma centers, 85% are affiliated with a National Institutes of Health (NIH)designated stroke center, 50% are affiliated with an NIHdesignated cancer center, and 51% cover a separate pediatric emergency department. 1332
Academic Radiology, Vol 21, No 10, October 2014
TABLE 1. Volume of Studies Read Annually. Proportion of Programs Volume of Studies >750,000 500,000–750,000 250,000–500,000 100,000–250,000
