Pandemic Effects on Resident Education and Training
It is no surprise that COVID-19 has significantly impacted all aspects of radiological practice and disrupted residency training.1,2 The challenges imposed by the pandemic have compelled the adoption of innovative methods to maintain radiologist productivity and continue trainee education safely. As we all adjust to a “new normal,” it behooves us to learn from initial experiences and plan for further adaptations as they may prove to be vital elements of residency education moving forward.
Challenges
- Training
Radiology resident training is multifaceted, involving performance of clinical duties with attending feedback and traditional lecture-based pedagogy. The pandemic has drastically disrupted resident training.2
- Case volume
Case volume and variety were significantly reduced both by policies to prevent disease transmission and diminished number of non-COVID-19 patients. Although case volume is recovering, the threat of subsequent waves of infection portends further disruptions into 2021.
- Reduced staffing
At our institution, both the on-site resident and attending radiologist cohorts were significantly reduced to accommodate social distancing restrictions. Many trainees were temporarily redeployed to other services and several became ill requiring quarantine. These modifications called for new workflows for procedures, on-call coverage, and remote read-out sessions.
- Lectures and conferences
Radiology residencies are conference-heavy — most having multiple lectures per day which were traditionally given in person by in-house attendings and experts from other institutions. Lectures were also a major component of society meetings and courses such as the American Institute for Radiological Pathology. Social distancing and travel restrictions rendered in-person lecture delivery and conference attendance unfeasible.
- Interviews
The in-person interview had been a mainstay of the residency and fellowship application process. Similar to other in-person activities, the extensive travel and close-quarters contact associated with in-person interviewing were untenable, and plans for in-person interviews were derailed for the 2020-2021 interview season.
Solutions
- Virtual read-outs
Secure web-based video conferencing platforms are being utilized to perform virtual read-outs.3 This approach restores continuity in workstation feedback and is even accessible to off-site trainees. There is certainly potential for continued use in a non-pandemic setting as trainees are often disseminated amongst various sites.
- Remote performance of clinical duties
Of daily radiologist responsibilities, protocoling often requires only basic EMR access and is conveniently performed remotely. If residents require assistance, attending consultation is available by phone. Off-site protocoling not only allows residents to remain clinically engaged but also reduces the load on the already diminished staff.
Not all clinical duties are readily performed remotely. At one of our institutions, the lack of both home reading stations and radiologist-specific remote PACS access prevented remote preliminary dictation. It is worth evaluating the possibility of remote resident reading stations and the basic satisfactory and cost-effective hardware configurations, which would make them feasible.
- Interdepartmental conferences
Interdepartmental conferences such as tumor boards and missed case conferences are increasingly being conducted remotely.
- Virtual didactic lectures and conferences
Remote conference delivery has previously demonstrated efficacy in radiology education and is currently extensively utilized.4 Numerous video conferencing platforms (VCPs) are available and offer varying degrees of interactivity, including participant polling and annotation. Some lecturers at our institutions coupled VCPs with third-party response systems such as RSNA Diagnosis Live to create a more engaging experience.
- National society conferences and collective curriculum
Video-conferencing was also adopted on a large scale by national organizations. Remote lecturing has the potential to standardize curriculum and bridge knowledge gaps between institutions – possibly compensating for the absence of particular subspecialty expert faculty within any given residency. Several organizations’ annual meetings were also converted to a virtual format. This format allows widespread and more affordable access, however, meeting like-minded professionals and role models (i.e. networking) is one main draw for conference attendance, and this component remains a challenge in an online setting.
- Video interviewing
Beginning in March 2020, numerous organizations released statements urging the adoption of remote interviewing for the 2020–2021 interview season. While remote interviewing allows for approaches such as asynchronous pre-recorded interviews, it is expected that most programs will adopt interactive video interviewing via VCPs as this most closely simulates the conventional in-person interview.
The remote video interview poses several challenges for programs and applicants alike. Interviewers and interviewees need to be adequately equipped with reliable computers and web-cameras as well as appropriate spaces to serve as backgrounds for the interview. This can potentially be a source of inequity as applicants and programs with greater resources may be able to arrange conditions with optimal hardware and background environments. Additionally, all parties should be well-versed in the use of a chosen VCP, which is ideally confirmed with a technical trial before the actual interview day.
Nevertheless, remote interviewing portends substantial benefits predominantly in the form of significantly reduced limitations for applicants. Applicants will not only save on costs of travel and lodging but can also minimize scheduling conflicts and time taken away from clinical rotations. In turn, this could allow applicants to attend a greater number of interviews than they would have otherwise and potentially identify programs that are better personal fits. Increasing application breadth is also expected to increase the overall diversity of any program’s applicant pool, which may lead to a greater overall variety of skills and perspectives amongst trainees.
With a crisis comes the opportunity for innovation. The pandemic has driven technological adaptations and created a chance to rethink radiology education fundamentally. COVID-19 has created considerable challenges for radiology residencies but has also provided a pivotal opportunity to restructure the basis of trainee education. We have been united by the challenges we face and have gained solidarity through surmounting them.
ENDNOTES
1. Cavallo, J.J. and H.P. Forman, The Economic Impact of the COVID-19 Pandemic on Radiology Practices. Radiology, 2020. 0(0):201495.
2. Alvin, M.D., et al., The Impact of COVID-19 on radiology trainees. 2020, Radiological Society of North America.
3. Li, C.H., et al., Virtual Read-Out: Radiology Education for the 21st Century During the COVID-19 Pandemic. Acad Radiol, 2020. 27(6):872-881.
4. Richardson, M.L., et al., Running an online radiology teaching conference: why it’sa great idea and how to do it successfully. Acad Radiol, 2012. 19(6):746-751.