Pandemic-related volume dips may have ‘dire’ consequences for radiology trainees, particularly IR students

Medical schools have been upended by the pandemic, with a new analysis suggesting that the massive declines in diagnostic and interventional radiology exams may have far-reaching consequences for trainees.

In fact, according to the research published Tuesday, during the height of lockdowns in April, the average IR student caseload dropped by more than half compared to that same month over the previous five years. This is likely directly due to the large dip in volumes most providers experienced, and continue to recover from, during the lockdowns.

And while teaching institutions have overwhelmingly turned their efforts toward online learning, the inability of students to log their clinical rotations, supervised interpretations and other educational requirements may lead to severe ramifications.

“Such significant decreases in case volume may impede diagnostic radiology resident’s ability to fulfill graduation requirements,” Ahmed M. Gabr, MD, with Oregon Health & Science University’s IR department, and colleagues wrote.

The situation may be even more severe for interventional radiology students. Gabr et al. went on to say: “for current IR fellows, the reduction in hands-on training could have more dire consequences given the relatively more compressed educational time frame and graduation requirement of 500 cases."

For their research, the authors traced radiology procedures performed at a single tertiary-care teaching hospital between 2015 and 2020. Compared to April of the prior five years, DR and IR case volumes fell off of a cliff. A 75.5% decline in women’s imaging led the way. Musculoskeletal (-54.2%), body imaging (-49.2%) and neuro exams (39.3%) followed closely behind.

And for interventional trainees, the average caseload dipped by 51.9%, caused primarily by drops in arterial procedures (-62.6%), neuro IR (-57.6%), and core IR (-42.6%).

To make up for these losses, the program increased the number of didactic hours taught each week. Such learning jumped 31.3% in April, all due to remote web-based programs and conferencing, the authors noted July 21 in Academic Radiology.

If imaging volumes continue to stagnate, Gabr and colleagues say programs should consider allowing residents to interpret already finalized studies from case archives as a potential way of fulfilling graduation requirements.

Simulated cases and virtual learning may be more effective for some, but the challenge is far greater for IR trainees, who require more tactile experiences.

“While remote access to radiology workstations and advances in telecommunications have enabled a remote learning environment in DR, the hands-on nature of IR training makes it more challenging in a virtual setting,” Gabr et al. wrote. “There is currently no sufficient evidence in the literature to support the validity of remote and simulated training in IR and its effect on patient outcomes.

Despite this, the group suggested societies such as RSNA, the Society of Interventional Radiology and the ACR should work to share recorded or live cases with trainees. Digital repositories for educational and rare cases will also help.

And simulator-based training and assessment, similar to the Objective Structured Clinical Examination used by medical schools could be particularly useful for IR trainees.

“The rate of change and adaptation within the healthcare system to the COVID-19 pandemic has been unprecedented,” the authors concluded. “It will be imperative for a concerted effort to begin at a national level inclusive of major stakeholders in DR/IR trainee education to collaboratively address how best to meet educational standards. Innovative ways to use existing technologies for virtual experiences could be leveraged to support this effort.”

Read the entire study here, including more suggestions on how to best leverage existing technologies for virtual learning.