Tag: AUR meeting

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AUR Update 2019: What’s In Store For Your Radiology Residency?

For those of you that don’t know, the Association of University Radiologists (AUR) annual meeting is the main forum for all radiology residency programs throughout the country to discuss the most critical issues affecting radiology residency programs, GME education, and radiology medical student education. These include anything from the radiology residency match to the job market as well as the hardcore academic issues.  So, once again, I would like to keep you up to date with the AUR update 2019 on what is new in radiology education and the main factors that may impact your training.

Radiology Match/Competitiveness

As I had previously promised in a previous blog on the match, I will provide with a summary of the numbers compared to past years. Slightly different from my experience in the match, the numbers pointed to an overall similar year for radiology residency competition. Compared the previous year, 18 spots were left open (previously ten places). And, the percentage of foreign graduates were also similar (32% vs. 29%). However, the number of applications per resident had increased significantly, perhaps driving somewhat more competitive applicants into the interview spots.

Given the numbers, however, the facts show no significant change in competitiveness from year to year. Interestingly enough, in my experience, the overall quality of the applications was higher. (my experience can differ from the overall statistics!) So, I believe that some increased self-selection has been happening, not measured by the statistics. In terms of competitiveness, one of the hot topics lectures stated that radiology this year was similar in competitiveness to emergency medicine.

The Job Market

Like the previous year, the future has become rosy for new radiology residency graduates. Droves of retiring radiologists and a good economy are leading to the robust job markets for new radiology resident graduates. Also, similar to the last year, there are nearly two jobs available for each diagnostic radiology residency graduate. I would say that is not too shabby!

Furthermore, the needs of practices remain similar to the past. Body imaging, neuroradiology, and interventional are the most common available first jobs. And, the greatest need for radiology practices remains breast imaging, body imaging, and neuroradiology. Most jobs posted are again available in the South and the least in New England.

What I found particularly interesting: 8% of all graduates were able to find a job with no fellowship training. I’m not sure what the statistics were for the previous years (probably a lower percentage in past years), but I have a feeling these folks would still have a hard time finding a position on the populated coasts. However, these statistics bode well overall for all graduates trying to find a job.

Change In Board Pass Rate Minimums

From an associate residency director of a “smallish” program, ACGME board passing changes have the potential to make some issues for smaller radiology residency programs. No longer is the minimum requirement an 80% pass rate for residencies by the end of the residency.  Instead, each program needs either an 80% first-time core examination pass rate or be over the 5th percentile for all residencies (that makes up about seven programs) with a look-back of five years. If you happen to have a “freak” year or two of a lower pass rate as a smaller program, the ACGME can target your residency for a new site visit. And, that can wreak all sorts of havoc!!!

Radexam

Now that the monthly evaluation exam has matured a bit, we have more details on this evaluation system. You can expect the availability of a more sophisticated assessment of individual scores and more customizable examinations to different institutions. You will see new exams in fluoroscopy, GI, and GU. Even the AIRP plans to have a distinct test to confirm that residents have attended the conference!
Also, they have instituted a new overall R3 level assessment test for these residents before going into the core exam. The examination will be available until June 20 and may be a great way to assess the progress of the resident for the core. We will see!

Unconscious bias

The quality of the speakers at the meeting varies widely. But, this year the AUR meeting provided us with a treat. Straight from the NPR news station, Shankar Vedantam gave an excellent lecture on unconscious bias and how that can affect radiologists when it comes to issues like the selection of diverse radiology residency applicants. No, it did not provide us with a formula for maintaining diversity in our residencies. But, it did give a new perspective on how we make the decisions that we do. If not this year or next year, I would expect some future changes in the rules for the overall process of residency selection and evaluation to incorporate some of the principles from this talk.

AUR Update 2019 and Change

The one constant in all radiology residencies is “change.” And, this year with the AUR update 2019 is no exception. Between the match, the improving job market, changing pass rate standards, an evolving Radexam, and new perspectives on unconscious biases, I foresee that our program, as well as all programs across North America, will have to roll with the punches and continue to adjust!

 

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The 2017 Annual AUR Meeting- A Radiology Residency Status Report

Each year in the heart of spring in the United States, academic/teaching radiologists get together at a different part of the country to discuss the newest teaching methods, radiology residency issues, and hot academic topics at a meeting called the annual Association of University Radiologists (AUR) meeting. For new applicants and radiology residents, this meeting is extremely important as it outlines significant changes to the training of radiologists throughout the country. This year is the first annual update from Hollywood, Florida. I am going to go over what I think are the most relevant and important topics at this conference for radiology trainees.

Increasing Competitiveness of Radiology Residency

Traditionally, it is somewhat difficult to measure competitiveness of radiology residency compared to other specialties. One of the more accurate methods is the United States senior U.S. fill rate. Since 2014, there has been a gradual uptick in the senior U.S. fill rate to 72% (last year 68%). In addition, the applicant pool is up 31 percent over the past 4 years. So, it appears that all this talk about artificial intelligence has not yet dampened the enthusiasm of radiology candidates!

There are always two sides to every story, however. Since U.S applicants usually get first priority, it is a bit more difficult for international medical graduates (IMGs) to get radiology residency slots. In fact, on a survey at the AUR meeting, it stated that only 64 percent of programs are willing to take international medical graduates. That number tends to go down as radiology becomes more competitive. Furthermore, programs are no longer able to accept foreign non-ACGME accredited preliminary year internships to satisfy the requirements of the clinical year.

Improving Radiology Job Market

According to the recent AUR survey, practices are increasing both new and current radiology job hires. In fact, projections show an increasing number of available jobs numbering about 2000 today (vs. 1300-1500 jobs a few years ago). The most popular specialties are body imaging, interventional radiology, and neuroradiology.  However, practices need breast imagers, interventional radiologists, and neuroradiologists the most. And, the majority of jobs are in private practice. That being said, large corporate practices do continue to increase hiring radiologists the most.

IR/DR and ESIR

Now that IR/DR is its own distinct specialty, it commanded a fairly competitive match this year. For this subspecialty, the fill rate with U.S. seniors was 85% versus 72% for diagnostic radiology. So by all accounts, the match was fairly successful. In addition, many new residency programs are applying to start up both IR/DR and ESIR programs. Both of these programs allow a resident to complete his/her entire training in 6 years. Unlike radiology residencies willing to add on these programs, residencies that do not start up IR/DR and ESIR programs will force their residents to have to complete a total of 7 years of residency/fellowship for interventional radiology trained subspecialists. Accordingly, those residencies not willing to add either ESIR or IR/DR programs are likely going to have difficulty recruiting new residents.

Rad Exam

The current in-service examinations do not correlate well with resident performance. In fact, many residencies (including my own) cannot utilize the test as a determiner of residency performance given the wide variability. In addition, there is no distinction in the testing questions between different residency levels. To remedy this issue, a new crowd sourced examination call Rad Exam is being created with institutional benchmarks and a large database. Time will tell if it becomes a useful examination to replace our current in-service examination, but it sounds very promising!

Simulation

Although not a discussed in conference at the AUR meeting, a vendor called Simulation was present and had an interesting solution for programs that want a structured precall examination. This company created an excellent standardized test that assesses finding and interpretive skills using a simulated PACS system to help define if a resident is ready to partake in independent call. Additionally, the test is benchmarked to other programs. It seems like it may be significant improvement over the current precall testing options.

ABR Core Examination Frustrations

Interestingly, according to faculty surveys, most faculty members reflect fondly upon the old oral board examination and give low marks to the new core examination as a means of  testing residents to meet basic radiology requirements at the end of their 3rd year. However, even more disappointing to me, the American Board of Radiology (ABR) now takes a new formalized position that they have no role in testing communication skills. In fact, they explicitly stated that their only role is the testing of medical knowledge. According to them, communication skills should be taught at the local residency level.

Call me crazy, but radiology is a specialty of communication, both written and oral, and not just a specialty of medical knowledge. If that is the case, does it make sense that the ABR as an accrediting body is not willing to standardize testing for communication skills as well as medical knowledge to establish a baseline level of competency? I think not. Academic radiologists need to push the board to change their stance regarding communication competency standardization with oral/written board testing!!!

Increasing Required Administration Time For Program Directors

And finally, on July 1, 2018, the ACGME will likely approve an increase in the minimum administration time requirements for program and associate program directors. Presently, program directors at small programs in the United States can have a few as 0.2 FTE time dedicated to radiology residency administration. That number is ridiculously small compared to other medical subspecialties. Now, that number is going to increase based on a sliding scale corresponding to size of programs in July, 2018 assuming approval by the ACGME. How is that going to affect incoming radiology residents? I believe it will significantly increase the productivity and efficiency of residency programs on issues as wide ranging as educational conferences, evaluations/assessments, milestones, and more… It has been long since overdue.

Summary

As I see it, these are some of the most pressing issues tackled at the AUR conference. There are certainly other issues faced by academic radiology programs. Some of them mentioned at the conference and others largely ignored. There is a bit of good and bad news from this conference for everyone involved in radiology residencies throughout the country. Until next year at the AUR meeting in Nashville, Tennessee!!!