|Year : 2015 | Volume
| Issue : 1 | Page : 68-73
Instituting a radiology residency scholarly activity program
Timothy J Amrhein1, Ali Tabesh2, Heather R Collins2, Leonie L Gordon3, Joseph A Helpern4, Jens H Jensen2
1 Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
2 Center for Biomedical Imaging, Medical University of South Carolina, South Carolina, USA
3 Department of Radiology and Radiological Science, Medical University of South Carolina, South Carolina, USA
4 Center for Biomedical Imaging; Department of Neurosciences, Medical University of South Carolina, South Carolina, USA
|Date of Web Publication||31-Jul-2015|
Timothy J Amrhein
Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710
Source of Support: None, Conflict of Interest: None
Background: The purpose of this manuscript is to present a newly instituted program for resident scholarly activity that includes a curriculum designed to enhance resident training with regard to research while meeting requirements established by the Accreditation Council for Graduate Medical Education (ACGME), the governing body responsible for regulation of post-graduate medical education and training in the United States. Methods: A scholarly activity program was designed with the following goals: (i) enhance the academic training environment for our residents; (ii) foster interests in research and academic career paths; (iii) provide basic education on research methodology and presentation skills. To guide program design, an electronic survey was created and distributed to the residents and faculty in the Department of Radiology and Radiological Sciences at the Medical University of South Carolina (MUSC), a 750-bed public teaching hospital in the state of South Carolina in the United States. Results: Survey respondents were in strong support of a required resident scholarly activity project (70% in favor), felt non-traditional projects were valuable (84.1% of respondents), and were proponents of required scholarly activity summary presentations (58%). This program requires that residents engage in a scholarly activity project under the guidance of a mentor. Resident success is maximized through in-house education initiatives focusing on presentation and research skills, protected time to work on the project, and oversight by a radiology research committee. All residents present a summary of their work near the end of their residency training. Discussion: Changes to the radiology resident certification process create an opportunity for incorporating new policies aimed at enhancing resident education. The scholarly activity program outlined in this manuscript is one such initiative designed to meet ACGME requirements, provide an introduction to research, and establish a scholarly activity project requirement.
Keywords: Program, radiology, residency, scholarly activity
|How to cite this article:|
Amrhein TJ, Tabesh A, Collins HR, Gordon LL, Helpern JA, Jensen JH. Instituting a radiology residency scholarly activity program. Educ Health 2015;28:68-73
| Background|| |
Residency training in the United States occurs after completing undergraduate education followed by four years of medical school. Radiology residency programs are four years in length and require as a prerequisite the completion of a one year internship, typically in internal medicine or surgery.
In 2007, the American Board of Radiology (ABR) announced significant changes to the certification process for radiology residents implementing a new unified core examination (beginning in 2013), to be taken after the completion of the first three years of training, and a certifying examination, to be taken 15 months after the completion of the four year residency training program. These changes provide unique challenges as well as new opportunities for radiology residency training programs.
After these changes are implemented, residents will have just 36 months to prepare for the core examination, which places a greater emphasis on the first three years of training and requires maximization of their educational yield. These changes also result in considerable latitude during the fourth year of residency training, as residents will have completed their core rotations and can instead focus on desired areas of concentration. The opportunity for greater subspecialty training was one of the ABR's stated goals in implementing changes to the certification process.  This latitude and subspecialization lends itself well to concomitant research endeavors and scholarly pursuits. In fact, the Association of Program Directors in Radiology (APDR) program director survey results revealed that the majority of program directors plan to allow fourth-year residents to use some of their focused training time for research if they so desire. 
The US Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Graduate Medical Education in Diagnostic Radiology state that "during their training, all residents must engage in a scholarly project under faculty supervision" and that "residents must have training in critical thinking skills and research design".  We feel that these requirements are best met through a formal mechanism, which, coupled with the changes to the certification process, have led to the creation of a well-defined scholarly activity program at our institution. The Medical University of South Carolina (MUSC) is a public medical school located in Charleston, South Carolina in the United States. MUSC's 750-bed teaching hospital is one of the oldest in the United States, initially chartered in 1834. It maintains robust teaching and research missions.
The purpose of this manuscript is to present a newly created institutional program for resident scholarly activity that includes a curriculum designed to enhance resident training with regard to research while meeting requirements established by the ACGME.
| Methods|| |
Prior to program design, an Institutional Review Board exempt survey was distributed to residents and faculty within our department, between April and June 2013.
A survey was designed using a Likert-scale format assessing contemporary opinions on the implementation of a scholarly activity program at our institution. Pilot surveys were generated and reviewed by senior faculty as well as a statistician. The survey was deployed electronically via www.surveymonkey.com with online links distributed to all residents and faculty within the MUSC Department of Radiology and Radiological Sciences over email. The survey consisted of 22 questions, with item subtypes as follows: "general" (1); "scholarly activity" (7); "teaching and mentoring" (7); "presentation skills" (7).
Survey-takers were required to respond to all questions and were informed of an expected survey completion time of approximately 10 min. No incentives were offered to respondents.
All analyses were conducted at the P < 0.05 threshold for statistical significance. To account for the survey responses being categorical data, in which there were fewer than five responses for some categories, Fisher's exact test was used for all analyses. All reported P values are two-sided.
| Results|| |
Thirty-six of 50 (72%) faculty members and 33 of 34 (97%) residents completed questionnaires (83.1% overall response rate).
Prior to implementation of the scholarly activity program (July 2013, after survey data acquisition) there were no specific requirements for resident engagement in scholarly endeavors, although participation was encouraged. When asked if residents should be required to engage in a scholarly activity project by the end of their four years of training, most respondents (70%) answered affirmatively [Figure 1]. The majority of faculty members responded positively (86%) as did residents (51%). However, there were some residents that responded negatively (30%).
|Figure 1: Results for: "Residents should be required to engage in a scholarly activity project by the end of their four years of training." Faculty were more likely to "agree" with this statement, whereas residents had a variety of responses, P = 0.007|
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While answers varied, respondents most often felt that "3-4 weeks" (41%) should be devoted to scholarly activity over the course of the four year residency, the duration of one rotation block in the current schedule. The overwhelming majority of respondents (84%) felt that non-traditional projects were valuable, for example, creating a radiology anatomy website, or projects focusing on the business aspects of radiology.
Most respondents answered that residents should have an identifiable faculty mentor for scholarly activity (73%) and that residents should be allowed to choose their mentor rather than have one assigned to them (94%).
A majority of respondents (81%) thought that developing radiology resident presentation skills was important. Finally, a requirement for residents to present a summary of their scholarly activity to the MUSC radiology department at the end of their fourth year was also generally supported (58%).
The results of this survey were instrumental in designing the scholarly activity program [Table 1].
| The Scholarly Activity Program|| |
Rationale and goals
The leadership of the MUSC Department of Radiology and Radiological Sciences created a scholarly activity program tasked with achieving the following goals: (i) Enhance the academic training environment and foster an interest in research and academic career paths; (ii) provide basic education on research methodology; (iii) provide guidance and education toward improving presentation skills; (iv) meet the ACGME requirements for research/scholarly activity for diagnostic radiology residencies.
| Program Design|| |
Central to the scholarly activity program is the requirement that every MUSC radiology resident engage in a scholarly activity project by the end of their training. All residents will be required to present their work to the MUSC radiology department at an annual research day in the spring of their fourth year. Resident success will be maximized through in-house education initiatives, protected time, structured mentorship, and oversight by a radiology research committee [Figure 2].
|Figure 2: Schematic representation of the MUSC Scholarly Activity Program timeline. (a) General overview of annually recurring events. (b) First and second years of radiology residency. (c) Third and fourth years of radiology residency|
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An educational program designed to complement the scholarly activity experience will focus on conducting research and improving presentation skills.
Research core curriculum
A series of eight 1-h lectures will be held annually designed to provide an introduction to research. While the curriculum may change as the scholarly activity program evolves, proposed topics include research ethics, design, methods, funding and grantsmanship, human subjects protection, dissemination of research findings (i.e., publications and authorship), intellectual property and commercialization, and two lectures dedicated to a brief review of selected research projects currently underway in the MUSC Department of Radiology and Radiological Sciences.
A multifaceted approach will be undertaken to improve resident presentation skills. First year residents will be given a didactic lecture on effective presentation skills that will focus on techniques for public speaking, use of an audience response system, and construction of PowerPoint presentations via the application of several commonly accepted principles in slide creation (i.e., sans serif font, the "rule of six", etc.). , First year residents will also spend several hours in an interactive "hands-on" PowerPoint workshop designed in conjunction with the MUSC computing center.
Residents will then put their newfound presentation skills into practice through a series of intradepartmental presentations. First year residents begin by presenting an initially unknown diagnostic challenge case to their fellow residents during noon conference, followed by a short (10-12 min) didactic PowerPoint lecture on the topic after the diagnosis is revealed. Second year residents will use PowerPoint to present one interesting case at a radiology faculty meeting (8 min presentation). Residents will receive anonymous constructive feedback (via summary email) from faculty members in the audience. Second year residents will also introduce one Grand Rounds keynote speaker. These intradepartmental presentations are designed to provide progressively larger and more senior audiences for the resident: Co-residents/peers, then faculty members, and finally the entire radiology department.
In addition to the above educational initiatives, the quality of resident presentations external to the department will be improved through direct oversight. Any resident presenting at a regional or national meeting will be required to also present to the radiology department. Specific grand rounds will be held for this purpose prior to major national meetings (e.g., Radiological Society of North America). For subspecialty meeting presentations, residents will present before a smaller subcommittee consisting of senior research faculty or to the appropriate clinical division.
All residents will be granted 1 week of dedicated time in either November or December of their third year of residency in order to begin efforts toward their scholarly activity. This time is intended to allow for the completion of time-sensitive preliminary efforts that might prevent successful project completion (i.e., IRB submission). Additionally, 1 month of dedicated time will be allotted during the fourth year, which we envision will be used to complete the project, perhaps involving final data collection, data analysis, and hopefully manuscript preparation. Care was taken to select weeks of protected time removed from the board exam preparation period to reduce the likelihood of it being used for alternative pursuits. Finally, residents may apply for additional dedicated time, if they wish to undertake a more expansive project.
Residents will be provided information on the value of mentorship in developing scholarly skills, and they will be asked to select a faculty mentor to assist them in their scholarly activities. Mentors will be chosen by the end of the second year. This deadline was chosen because it is near the time that residents decide on a fellowship/subspecialty, and it provides ample opportunity for outlining a project plan prior to the 1 week of dedicated time in the third year.
Scholarly activity oversight
A subcommittee of the Radiology Research Committee will be designated to oversee the progress of the scholarly activity projects. This subcommittee will convene semi-annually to individually review all active resident projects.
This program was intentionally entitled a "scholarly activity" rather than "research" program to allow residents the opportunity to engage in endeavors beyond the scope of traditional research, for example, the creation of a radiology anatomy website, an international radiology project, or a project focusing on the business aspects of radiology. We hope that this latitude will encourage intellectual exploration and believe that this will maximize both residents' interest as well as their chances of success.
| Graduating with Distinction in Scholarly Activity|| |
A separate distinction will be available to residents with a particular interest and aptitude for scholarly activity. Achieving this distinction will depend upon successful application to the Research Committee during the fourth year of training. Evaluation criteria will include, but not be limited to, first author publications in peer-refereed journals and presentations at national meetings. This separate designation will be recognized by the Radiology Chair and will be formally acknowledged at graduation.
| Discussion|| |
The creation and implementation of a scholarly activity program at our institution is intended to fulfill the mandatory ACGME residency program requirements as well as to take advantage of recent changes to residency training inherent with the new ABR certification exam. We believe that a formal process will allow our residents to obtain the greatest yield from these endeavors.
While the survey results presented in this manuscript are limited to opinions elicited from residents and faculty at a single, average-sized academic institution, it is the authors' hope that they are indicative of opinions toward similar changes at other institutions. Overall, there was considerable support amongst both faculty and residents for a formal scholarly activity program. This included support for mandatory project requirements and summary presentations, even among the resident respondents.
In designing the program, considerable attention was placed on establishing mechanisms to ensure that dedicated time provided to the residents for project work was used for its intended purpose. Removing this time from the typical board preparation period was felt to be of paramount importance, a sentiment echoed by survey respondents. The authors of the program also included directed individual faculty mentorship, biannual committee review of all active projects, and a mandatory final presentation to the department as mechanisms to help achieve this end. It was particularly interesting that mandatory mentorship was supported strongly by both residents and faculty. Additionally, the vast majority of respondents from both groups felt that residents should be able to choose their mentor.
The requirement for a summary presentation to the department prior to graduation is intended to motivate residents to work hard toward project completion. These presentations are intended to be an inspiration for the department and an opportunity to celebrate resident achievement. This requirement will not be waived under any circumstance, to avoid ambiguity and prevent requests for exceptions.
The program will allow for flexibility in both types of projects and in allocation of dedicated time, with adjustments made on an individual basis. Residents with strong interests in academic careers or challenging translational scientific projects may request additional time to dedicate toward scholarly activity. Additionally, non-traditional projects will be encouraged and approved on a case-by-case basis to allow for creativity. Residents strongly viewed non-traditional projects as valuable.
We decided against requiring authorship in the final version of the scholarly activity program. Successful publication in a peer-reviewed journal often requires considerable effort from several co-contributors and is dependent upon multiple factors external to the resident's efforts and ability, including the opinions of journal reviewers. Further, given the short time allotted to complete projects, many resident scholarly activity efforts may result in publication of manuscripts after the completion of the residency-training program. Finally, manuscript publication is a traditional metric that may not be applicable to many non-traditional projects.
There are several aspects of this scholarly activity program that could make it difficult to implement at other institutions. Residency programs need to have the capacity to provide residents with dedicated time off the clinical schedule in order to allow for scholarly activity projects. Also, there must be adequate numbers of able and committed faculty mentors and educators. Nevertheless, we believe that the program as outlined can be implemented at most radiology residency programs throughout the United States and has many underlying principles that are more broadly generalizable to residency programs around the globe.
| Conclusion|| |
Changes in the ABR certifying examination require adjustments to the structure of radiology residency programs and provide an opportunity to implement new policies and educational methods. The scholarly activity program outlined in this manuscript is one such modification initiated at the Medical University of South Carolina that meets ACGME requirements, provides an introduction to research, and mandates engagement in a scholarly activity project. While other institutions have previously successfully implemented programs that have encouraged scholarly activity and research, they have been designed to function at major medical centers and require either the presence of excellent fellowship programs in all subspecialties of radiology or a dedicated separate research track.  These initiatives are, therefore, unrealistic for most residency programs. We believe that the program outlined in this manuscript can be implemented at most academic radiology residency programs in the US. Furthermore, its principles are generalizable and can be applied to graduate medical education programs in fields other than radiology as well as those outside of the United States.
| Acknowledgment|| |
The authors would like to acknowledge Drs. Maxfield, Nelson, Gray, and Ravin at the Duke University Medical Center Department of Radiology for their pioneering work in the creation of the 3/2-residency program, which served as inspiration for the MUSC Scholarly Activity Policy. The authors would also like to acknowledge Dr. Walter Huda for his invaluable assistance in creating the survey instrument.
| References|| |
Amis ES Jr, Dunnick NR; American Board of Radiology; Diagnostic Radiology Residency Review Committee. Improvement in radiology education: Joint efforts of the American Board of Radiology and the Diagnostic Radiology Residency Review Committee. J Am Coll Radiol 2009;6:103-5.
Deitte L, Chertoff JD, Mainiero MB, Strife JL, DeStigter KK. Challenges and opportunities in restructuring radiology residencies: The APDR Residency Restructuring Committee report. J Am Coll Radiol 2010;7:507-11.
Collins J. Education techniques for lifelong learning: Making a PowerPoint presentation. Radiographics 2004;24:1177-83.
Collins J. Education techniques for lifelong learning: Giving a PowerPoint presentation: The art of communicating effectively. Radiographics 2004;24:1185-92.
Maxfield CM, Nelson RC, Gray-Leithe L, Ravin CE. Successful implementation of a universal 3/2 radiology curriculum. Acad Radiol 2010;17:116-9.
[Figure 1], [Figure 2]
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