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2013 A 3 CR 2 Annual Chief Resident Survey. Anup Shetty, MD Mallinckrodt Institute of Radiology. St. Louis AKA The Lou, Mound City, Gateway to the West. Survey Format. Confidential online survey (surveymonkey.com) - PowerPoint PPT Presentation
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2013 A3CR2 Annual Chief Resident Survey
Anup Shetty, MDMallinckrodt Institute of Radiology
St. LouisAKA The Lou, Mound City, Gateway to the West
Survey Format
• Confidential online survey (surveymonkey.com)
• Multiple choice questions (single and multiple answer), free text for additional comments
Survey Purpose
• Share facts and information about the structure of training programs
• Use information about resident benefits to address shortfalls at individual programs
• Share opinions of fellow chief residents about important issues facing radiology training
• Share ideas for how to deal with these important issues
Survey Topics
• Recurring – Basic Program Information and Resident Benefits– Chief Resident Responsibilities– Call and Outside Hospital Studies– New Board Exam Format and its Impact On:
• Curriculum, Call System, Fellowships– Ultrasound and MR interpretations on call– Healthcare Reform and its Economic Impact on Residency Programs, Fellowships, and
the Job Market– Practice Quality Improvement
• New in 2013– Overreads– Sick Resident Coverage– Senior Selectives/Mini-Fellowships– Core Exam Board Review Format– Feedback/Safety Training
Limitations
• Opinions and estimations
• Sampling bias (only chief residents included)
• Duplicate responses from programs with multiple chief residents– We attempted to exclude them from the relevant data sets
PROGRAM DETAILS
Participation
• Results will be available to A3CR2 members by e-mail on request• Results will also be available to A3CR2 members in the newsletter and on the website
THANK YOU FOR PARTICIPATING!
Year Individual Responses
Unique Programs
2013 134 992012 185 1352011 259 1482010 228 1402009 143 1122008 100 ---
Number of Responses 2008-2013
* Out of approximately 187 programs in the US
43%
18%11%
12%
15%NORTHEAST (CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT)CENTRAL (IA, IL, IN, MI, MN, MO, OH, WI)SOUTHEAST (AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV)PACIFIC (AK, CA, HI, NV, OR, WA)WESTERN (AZ, CO, ID, KS, MT, ND, NE, NM, OK, SD, TX, UT, WY)
Program Size
Changes in Size• Increase in program size over
10 years– Total # residents increased 29%
from 2003 to 2013– # women residents increased
47% from 2003 to 2013
2003 2009 2011 2012 20130
5
10
15
20
25
30
Average Number of Residents Per Program
2003 2009 20130
5
10
15
20
25
30
Gender Distribution of Residents Per Program
MaleFemale
Hospital Coverage
• More residency programs are increasing # hospitals they cover for training
2005 2009 2011 20130
5
10
15
20
25
30
35
40
45
% Programs Covering Varying # of Hospitals
12345+
Level 1 Trauma Stroke Center NIH Cancer Center Pediatric ED0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
83.7% 85.7%
54.1% 55.1%
Type of Institution
Volume
Annual # CT scans (millions) per year*
* Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007 Nov
29;357(22):2277-84
2004 2009 201305
101520253035404550
Proportion of Programs with Specified Volume of Radiologic Studies Per Year
<100k101k-250k251k-500k501k-750k>750k
Medical Student Recruitment
Hosted Radiology Interest Group meetings
Set up shadowing experiences in the reading room/procedure rooms
Integrate radiology basics into anatomy courses/3rd year clerkships
Provided formal teaching sessions for USMLE Step 1/2
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Medical Student Teaching/Recruitment
Others• Integrate medical students into research projects• Ultrasound workshops
RESIDENT BENEFITS
Book fund
Travel stipend
Conference registration fees
Time off for educational (non-presenting) conferences
ABR examination fees
AIRP tuition
AIRP housing and/or travel stipend
Lead aprons
Review course tuition and/or travel stipend
STAT Dx
RAD Primer
E-Anatomy
Tablets or other electronics for education
0 10 20 30 40 50 60 70 80 90 100
89
82
76
77
25
90
81
41
49
95
56
26
27
200820122013
Resident Benefits
Average Amount = $1800 ($400-$7500)
% Residents that attend AIRP = 96%
Other Benefits: meals, parking, computer fund, happy hours,
flexible funds
Vacation and Salary
Resident Salaries have increased 8.2% for PGY-2 and 6.9% for PGY-5, roughly in line with core US inflation of about 7% from
2009 to 2013
2 3 4 5$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$52,279 $54,348 $56,519 $58,672
Average Salary by PGY 20092013
2%
31%
1%58%
3%
Proportion of Residencies by Weeks of Vacation
2.5 3 3.5 4
5
Family Leave
% Programs offering Family
Leave
% Programs with Family Leave taken from All, Some, or
None of Vacation/Sick Days
% Programs offering Family
Leave
% Programs with Family Leave taken from All, Some, or
None of Vacation/Sick Days
For Pregnant Residents For Significant Others of Pregnant Residents
Yes 97%
No 3%
Yes 85%
No 15%
All 22%
None 44%
Some 34%All 27%
Some 25%
None 48%
CHIEF RESIDENT
Chief Resident Selection
Residents Choose 18%
Combination 51%
Chair-person and/or
Program Director Chooses
24%
Other 7%
OtherAll Seniors are Chiefs
All faculty and/or residents voteEducation committee chooses 1 2 3 4
0
10
20
30
40
50
60
70
10
64
12
4
Chief Residents Per Program
Chief Resident Responsibilities
Others• Emergency coverage• QA/town hall meetings• Physics curriculum
Call schedule
Rotation schedule
Vacation schedule
Attending lecture / conference schedule
Curriculum development and evaluation
Resident recruiting
Resident selection
Social events
Managing Disputes
Resident teaching
Medical student teaching
Boards review organization
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
96%
84%
85%
43%
60%
82%
81%
59%
89%
54%
39%
59%
Chief Resident Benefits
Average Salary Bonus$2248, previously $1932
Extra con-ference time
Conference costs paid
Administrative time off service
Chief office Salary or other bonus
0
10
20
30
40
50
60
70
80
46 46
3328
75
CALL, WEEKENDS, AND ATTENDING COVERAGE
0%
10%
20%
30%
40%
50%
60%
70%
19%16%
60%
5%
29%
20% 19%
60%
1%
19%19% 21%
56%
1%
14%
Type of On-Call Report
2011 2012 2013
Call and Weekend Coverage
• Short Prelim depending on modality (US, neuro)
• ER cases finalized with attending, inpatient cases prelimed
• Site dependent
Ultrasound Coverage
Specific SituationsOb-Gyn Service performs Pelvic US
Vascular Surgery Service performs DVT USResident performs certain studies
(RUQ, Scrotal, Renal)
In-house Sonographer depending on time, hospital, and day of the week
24 Hour Sonographer Home Call Sonographer On-Call Resident0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
29%
44%
13%
46%
38%
16%
47%
37%
15%
2009
20122013
MRI Coverage
Specific SituationsEmergent MR Examinations only
“STAT” Examinations onlyER or Inpatient MR Exams only
Specific SituationsResidents provide Prelim ReportsTelerad service reads MR exams
Read only by request (i.e. if clinician calls)Complex cases read by attending only
Depends on study (i.e. Cardiac read only by fellows)
Neuro Body MSK Vascular None0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 91%
71%
57% 54%
7%
Programs Reading After-Hours MRI*
On-Call Res-idents
Fellows Attendings Not read0%
10%20%30%40%50%60%70%80%90%
100% 87%
14% 15% 10%
Who Reads MRI After Hours
*No significant change from 2012
Weekend Coverage
Half Day Saturday Full Day Saturday Half-Day Sunday Full Day Sunday Not Provided0%
10%
20%
30%
40%
50%
60%
70%
20%
64%
16%
53%
16%
Programs Covering Routine Services on the Weekend
2011
2012
2013
Readout Format
Specific SituationsFace-to-face readout for Neuro Studies only
Face-to-face readout for junior residents onlyFace-to-face readout only if there is a question on the study
Most/All of the Time Some of the Time No Face to Face Readout
In-House Attending0%
10%
20%
30%
40%
50%
60%
35%
18%
28%
16%
How Often Post-Call Face to Face Readout Occurs
2011 2012
2013
Overread Procedure
Specific SituationsNot applicable to programs with overnight in-house attendings
Resident C
alls R
eferrin
g Doc
Attending calls
Referring Doc
Referri
ng Doc C
ontacts Patient
Residen
t Contacts
Patient
Attending Contacts Patient
Overread Docu
mented
Informal
Overread
0%
10%
20%
30%
40%
50%
60%
70% 66%58%
40%
0% 2%
54%
2%
After Hour Attending Coverage
• Frequently section-dependent• ER-specific coverage 24 hrs
3% programs plan to implement extended in-house attending coverage (5-10pm) within the next year
7% programs plan to implement overnight in-house attending coverage within the next year
29% programs do not plan to implement extended in-house attending coverage
Normal attending work day
Extended Attending Hours
24/7 Attending Coverage
Attendings Review All Cases at Home
Attendings Review Select Cases at Home
External telerads over-reads residents
Other
0% 10% 20% 30% 40% 50% 60%
40%
46%
24%
3%
43%
15%
18%
2013
2012
2010
Sick Resident Coverage
Resident P
ulled Fr
om Other S
ervice
"Jeopardy"
Resident
No Resident P
ulled
Other0%
10%20%30%40%50%60%70% 59%
12%
34%
15%
Regular Shift Coverage
"Jeopardy" Resident
Chief Finds Coverage
Resident Finds
Coverage
No Resident Pulled
Other0%
10%
20%
30%
40%
50%
60%
70%
16%
63%
40%
5% 4%
Call Shift Coverage
Specific SituationsMore frequently pulled for procedural
services (IR, US)Service dependent
Specific SituationsResident scheduled for next shift coversStaff may cover if no other alternative
EXAM OF THE (VERY NEAR) FUTURE
ABR Core Exam
Disadvantages Expressed
Loss of focused period of consolidating knowledge, not just for exam but for future career 15 month wait period post-graduation to be board-certified No testing of interpersonal skills Studying for MCE, less real-world application of knowledge
Advantages Expressed Incorporates physics into clinical knowledge Synthesizes knowledge earlier in training Fairness of testing
Very Pos-itive
Positive Mixed Negative Very Negative
0%
10%
20%
30%
40%
50%
60%
70%
2%
9%
56%
21%
7%
Sentiment Towards New Exam Style
2012
2013
Changing Board Examination
3 yr "core" curriculum in place
Plan to have 3 yr "core" curriculum before EOF
Plan to have 3 yr "core" curriculum after EOF
No plan to change to 3 yr "core" curriculum
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
5%
19% 18% 17%
34%
46%
7%
13%
41%
35%
7%
17%
45%
22%
18%
6%
Plan to Change to 3 Year "Core" Curriculum
2010
2011
2012
2013
Continue Normal Rotations
Selectives/"Mini-Fellowships"
Start Fellowship ("3+2 Curriculum")
Research
Fill in Deficits From 1st 3 years
Combination
Undecided
Other
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
21%
61%
6%
1%
16%
15%
29%
13%
26%
60%
7%
1%
12%
17%
23%
18%
26%
82%
6%
4%
26%
24%
6%
18%
Plans for 4th Year (PGY-5) Curriculum
2013
2012
2011
Changing Board Examination
Other PlansContinue fulfilling Mamms and Nucs
requirementsRemediation in sections of poor
performance“Mini-fellowships” are optional
Time Off Service
Time Out of Call Pool
Lighter Rotations
No Protected Study Time
Undecided
0% 10% 20% 30% 40% 50% 60% 70%
21%
40%
11%
45%
25%
50%
13%
36%
21%
62%
50%
18%
18%
Plans for 3rd years (PGY-4) Preparing for the Core Exam
2013
2012
2011
Changing Board Examination
Changing Board Examination
Junior Residents Fellows Attendings I don't know Other (please specify)0%
10%
20%
30%
40%
50%
60%
70%
80% 73%
0% 0%
10% 14%
Coverage for Residents Studying for Exam
Average Weeks Out of Call Pool / Off Service (If Given)Call Pool
10.2 weeks (2-52)
Off Service
5.7 weeks (1-12)
Changing Board ExaminationPlans for board reviews for the new board exam structure
Internal Board Review
No Internal Review, Time for External Review
No Internal or External Review
0% 10%20%
30%40%
50%60%
70%80%
90%100%
79%
20%
1%
84%
13%
3%
87%
11%
2%
Oral Board Review
2013
2012
2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
29%
38%
3%
20%
8%
29% 29%
Core Board Review
2011 2012 2013
Changing Board Examination
0%20%40%60%80% 77%
4%27%
13% 8%
Preparation for Non-Interpretative Skills (e.g. Physics, Safety)
Other Schemes• Funding for external physics review course• Physics problem-based learning in lieu of traditional lectures
Selectives/”Mini-Fellowships”
0%30%60%90%
82%51% 62%
Purpose of Selectives
Weeks Allotted in 4th Year24.4 weeks average
(8-52 weeks)
1 2 3 4 5 6 70%
5%
10%
15%
20%
25%
30%
7%
26% 27%
14%
3%
12% 12%
How Many Individual Selectives Are Available to 4th Years
Selectives
Functions as Fellow
Some Responsibilities of Fellow
Functions as Senior Resident
Academic Time
Out of Call Pool
0% 10% 20% 30% 40% 50% 60%
35%
38%
54%
8%
1%
Selective Details
Notes• Space limitations on high demand mini-fellowships (e.g. Breast, MSK)• Research track mini-fellowship a possibility
FELLOWSHIPS
Fellowships
Ab-domen
Body Breast Cardiac Chest MRI MSK Neuro Neuro IR
Nucs Peds VIR0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%How Are Fellowship Applicants Interviewed?
This fellowship program in-terviews outside applicants before offering positions to internal candidates
This fellowship program has an early acceptance policy in place for internal candidates
There is no fellowship program for this subspe-cialty at my institution
Fellowships
Abdomen Body Breast Cardiac Chest MRI MSK Neuro Neuro IR Nucs Peds VIR Other0%
5%
10%
15%
20%
25%
5%
12%13%
1%1%
3%
15%
18%
1%2%
8%
22%
1%
What Fellowships 4th Years are Pursuing
2009 2012 2013
Ab-domen
Body Breast Cardiac Chest MRI MSK Neuro Neuro IR
Nucs Peds VIR Other0%
5%
10%
15%
20%
25%
1%
5%6%
0% 1% 1%
7%9%
1% 1% 1%
9%
0%
4%
8%
7%
0% 1%2%
7%
9%
1%1%
6%
13%
1%
Distribution of Internal vs External Fellowships
External Fellowship Internal Fellowship
Fellowships
EDOnc Imaging
Private practice
7% of Residents Planning on Doing Two Fellowships
HEALTHCARE ECONOMICS AND THE JOB MARKET
Healthcare Economics and the Job Market
Very Worried Worried A Little Worried
Not Worried0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
18%
29%
36%
9%
33%
40%
26%
1%
Sentiment About Current Job Market
2011
2013
No; 75%
Yes; 24%
Already Have One; 1%
Have You Started Looking for a Job?
Healthcare Economics and the Job Market
Fellowship95%
Private Practice2%
Academic2%
Military1%
Short-Term Plans Following Graduation
Private Practice30%
Academic35%
Mil-itary1%
Undecided34%
Long Term Plans After Gradu-ation
Healthcare Economics and the Job MarketHow the Current Economic Environment and Current Job Market Influences Career Plans
What are you willing to compromise to obtain a job?
Little/N
o Influence
on Career Planning
Academic M
ade More Appealin
g
Private Practi
ce M
ade More Appealin
g
Increases In
terest in Fe
llowship Training
Decreases In
terest in Fe
llowship Training
Change Fello
wship Choice0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50% 48%
22%
13%
37%
3%
12%
2012
2013
Less Va-cation Time
Lower Salary
More Call Shifts
More Weekend
Shifts
Less Ideal Location
0%
10%
20%
30%
40%
50%
60%
70%
80%
53%
71%
51%
44%
60%
2012
2013
• 92% (prev 86%) feel practices will try to increase their volume to maintain a similar salary despite the lower reimbursement rates
• 70% (prev 65%) feel it will discourage top-tier medical students from choosing radiology– 0% feel it will encourage top-tier medical
students to choose radiology
• 40% (prev 36%) feel that practices are going to be looking for radiologists trained in more than one fellowship
Healthcare Economics and the Job Market
What effects do you think healthcare reform will have on radiology? Does your program offer
some training in healthcare economics and
radiology business?
None31%
Adequate32%
Inadequate37%
Healthcare Economics and the Job Market
• 61% programs with # trainees = training “cap”• 12% programs with # trainees > training “cap”
• 13% programs planning on increasing # trainees• 7% programs planning on decreasing # trainees• 34% programs not planning on changing # trainees
• 2% programs planning on increasing # fellows• 12% programs planning on decreasing # fellows• 23% programs not planning on changing # fellows
Poor economic climate has lead to budget issues at some programs, esp. programs that have more trainees than its
training “cap,” paying for a certain # trainees out of pocket. such programs may need to downsize # trainees
MISCELLANEOUS
Quality Improvement
How well does your training program prepare you for ABR’s PQI requirements?*
ABR requires radiologists to document participation in 3 successful PQI projects every 10 years to maintain board certification Ad
equate 64%
Inadequate 25%
Not at All 10%
0 1 2 3 4+0%
10%
20%
30%
40%
50%
60%
17%
57%
17%
3%6%
PQI Projects Participated In*
Nothing
Time O
ff Clinica
l Service
Financia
l Support
Facu
lty M
entor
Other Reso
urces
0%10%20%30%40%50%60%70%
30%
13%4%
60%
46%
Program Support for Resident PQI*
*No significant change from 2012
Resident Feedback and Requirements
Signing Time Volume Overread Rate Dictation Corrections0%
10%
20%
30%
40%
50%
60%
70%
15%
69%
29%
57%
Resident Performance Feedback
Regular Lectures Computer-Based Modules
Teaching at Workstation
Self-Study Other0%
10%
20%
30%
40%
50%
60%
70%
80%
78%
30%44%
67%
7%
Safety Training (Radiation, MRI, Contrast, Sedation)
Simulation Lab
Resident Feedback and Requirements
Procedure Logging Software
Program-Specific Database
Residents Keep Own Other0%
10%
20%
30%
40%
50%
60%
70%
52%
16%
60%
4%
Procedure Logging
Procedure Competency Notes• About 50 % of programs have minimum procedure requirements, apart from I-131 mandated
by NRC• In IR, competency may need to be demonstrated prior to performing procedure independently• Competency requirements can be by individual procedure such as knee MRI, LP or PICC
DISCUSSION
Discussion• Total # residents increased 29% from 2003 to 2013, with
greater proportional increase of female residents (47%)• Resident salaries have increased at roughly the same
pace as U.S. inflation since 2009• E-Anatomy (3% -> 16%) and RadPrimer (16% -> 56%)
have increasingly been provided as resources to residents
• About 96% of residents attend AIRP, with an average stipend of $1800
• Slightly more programs offering full-day Saturday/Sunday services
Discussion• Fewer programs consistently read-out post-call
residents face to face (49% -> 35%), with more programs not having post-call readout (21% -> 28%)
• Only ~50% of programs document overreads• 24 hour attending coverage has doubled from 2009
(12%) to 2013 (24%)• Chiefs are concerned about the Core Exam format not
testing the skills that will be valuable in practice• 82% of programs plan to offer 4th year mini-
fellowships; average of 24 weeks allotted
Discussion• Programs giving 3rd years study time plan to offer 10
weeks of time off call and 5.5 weeks off of service• 73% of residents are worried or very worried about
their job prospects now, compared with only 47% in 2011, and are willing to make more compromises to secure a job
• 70% feel health care reform efforts will discourage top-tier medical students from a career in radiology
Future Directions• How successful were our board preparations
for the core exam• How senior selectives were received• ACGME residency milestones• Informatics
Thanks!• Chief Resident Participants
• Laurie May at RSNA
• Gautham Reddy and the A3CR2 Leadership
• Jennifer Gould and Ron Evens
• Steve Sauk, Elizabeth Sheybani, Colin Thompson, David Slat and Taylor Stone
• To Request Data from this Survey: [email protected]