A3CR2 Chief Resident Survey

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A3CR2 Chief Resident Survey

• Mallinckrodt Institute of Radiology
• St. Louis, MO

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Purpose

• Information Gathering
• Facts about the structure of training programs
  across the country
• Opinions regarding features of the training
  process and environment
• Ideas for promoting or responding to change in
  academic and professional arenas

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Survey Format

• On-line survey
• Predominantly multiple choice
• Options for open response where appropriate

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Survey Limitations

• Sampling bias
• Multiple responses from single institution
• Not a scientific process

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Survey Topics

• Repeat Questions
• Basic Program Details
• Resident Benefits
• Chief Resident Duties
• ACGME Guidelines
• Call
• Oral Board Preparation

• New Questions
• Plans After Residency
• RRC Program Changes
• Deficit Reduction Act

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2007 Chief Resident Survey

• 187 Surveys Requests
• 139 responses received
• 65 of respondents were incoming chiefs
• 84 from university affiliated programs
• 74 response rate
• 28 in 2005
• 55 2004
• Thank you!

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Results
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Basic Program Details
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Basic Program Details
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Basic Program Details
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2006-07 Residents

• Total of Residents
• R1 6.8 (1-18)
• R2 6.8 (1-18)
• R3 6.8 (1-18)
• R4 6.6 (1-17)
• Comparison to 2005 5.8 (R1-R4)
• 27 Female
• Comparison to 2005 34

Basic Program Details
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2006-07 Fellows

• 39 Female

Basic Program Details
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2006-07 Staff

• Female 26

Basic Program Details
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Resident Benefits

• Salary
• R1 44,300 (35,000-65,000)
• 2005 43,195
• 2002 37,913
• R4 50,300 (42,000-80,000)
• 2005 49,407
• 2002 45,522
• Tax-Deferred Retirement Savings Plan
• Available to 68 of residents
• Only 26 receive matching funds

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Costs Assumed by Training Program

• Temporary Medical License 41
• 50 in 2005
• Permanent Medical License 17
• 31 in 2005
• Book/Travel Fund 81
• Average 850
• 2005 722
• Lead Aprons 48

• BLS 77
• ACLS 71
• AFIP Tuition 93
• AFIP Housing Stipend 75
• Oral Board Review Course Tuition 46
• Oral Board Review Course Stipend 28

Resident Benefits
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Child Care

• 80 provide paid maternity leave
• Avg Length 6 wks
• Range 0-12 wks
• 68 provide paid paternity leave
• Avg Length 10 days
• Range 0-6 wks

Resident Benefits
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Chiefdom

• Average of 2 chiefs per program
• Range 1-4
• Term spans mid-third to mid-fourth year for 74
  of respondents

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Chiefdom
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-Average Salary Bonus 2,000 (0-10,000)-Other
Chief mug and chair!
Chiefdom
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ACGME Compliance

• 100 report complete compliance
• 97 Positive effect on resident quality of life
• 94 Positive effect on resident education
• Average hours off between shifts
• lt10 0 10-12 18 12-15 62 gt15 20
• lt10 11 in 2005
• Average work week
• 57 Report between 51-60 hours
• Averages on busiest rotation
• 61-70 hours 32 71-80 hours 28 gt80 hours
  10
• 80-hour work week is an average over 4 weeks

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ACGME Compliance

• Required work hours log 67
• Average call frequency per week
• 28 lt1 58 1 12 2 2 3
• 2005 Comparison
• 53 lt1 47 1-3
• Average days off per month
• 12 4 24 5 42 6 22 7
• 2005 Comparison
• 27 4-5 64 6-8

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Life After Residency

• 91 pursuing fellowship training
• Military Service 7
• Private Practice 65
• Academic Practice 35
• 11 of programs offer monetary incentive program
  for entering academic practice

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Life After Residency
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Life After Residency
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Call

• Average of residents in-house on call 1.8
• Range 1-5
• In-house call shifts (excluding NF)
• lt50 47 51-75 13 gt75 41
• 2005 Comparison 58 (average)
• Home/beeper call shifts (excluding NF)
• 0 36 1-40 29 41-75 27 gt75 10
• 2005 Comparison 78 (average)

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Call

• 73 of programs use night float system
• 67 in 2005
• 61 in 2004
• Weeks on night float during residency
• 0-4 wks 9 4-8 wks 20
• 8-10 wks 21 gt10 wks 50
• Length of night float shifts (hours)
• lt8 0 8-10 6.2 10-12 44
• 12-14 46 gt14 4
• Frequency of night float shifts
• QD 63 QOD 3 Other 35

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Call
28
Call
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Call

• Process for approving studies ordered on-call
• Sieve 35
• Ordering MD speaks directly to resident 43
• Ordering MD speaks to physician extender first
  appropriate calls forwarded to resident 25
• Other 30 (Computer based, Resident only called
  for protocols)
• In-house moonlighting 39
• Examples
• Weekend Neuro Call 720/day
• Assist ED Attending On-Call 100/hr
• Overflow Studies in evenings, weekends
  600-800/day
• Contrast Injection Monitoring 50-60/hr
• IR Home Call 1,000/week
• On-call McMeal vouchers or other free food 87

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Oral Board Preparation

• 79 of programs provide their own oral board
  review and curriculum
• Structured review begins
• Jan-Feb 62
• March-April 33
• Before Jan 5
• Oral board review
• Lectures given by faculty 97
• Lectures organized by faculty 30
• 70 of programs include a mock exam as part of
  preparation

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Oral Board Preparation
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ACGME Program Requirements

• 69 have core didactic lecture curriculum

• 80 give lectures as 1-hour block/day
• 6 group lectures into a larger block once/wk

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ACGME Program Requirements

• Required research/academic project 64
• Current protected academic time for project
• 25 Yes
• Anticipate giving protected academic time
• 23 Yes
• Most suggested 4 weeks of elective time

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ACGME Program Requirements

• 69 of programs currently require maintenance of
  a learning portfolio
• 75 currently employ 360 evaluations
• 95 of programs currently require an annual
  objective examination (e.g. ACR Inservice)

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ACGME Program Requirements

• Duration of training after which call currently
  begins (in months)
• lt6 18 6-9 57 9-12 12 gt12 12
• 66 of residents stop taking call midway through
  fourth year
• 11 stop at end of third year
• 14 continue throughout fourth year

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ACGME Program Requirements
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97 of attendings not in-house are available by
pager
ACGME Program Requirements
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ACGME Program Requirements

• 92 of resident reviewed studies on-call are
  currently reviewed within 24 hrs
• Restricting call until 12 month of radiology
  residency training will change
• Resident call system 73
• Attending/fellow call system 18

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Deficit Reduction Act
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Discussion

• Unique program structures
• 3/2 programs
• 9 clinical months spread throughout 5-year
  training program rather than doing PGY1
  internship
• Props
• Excellent pathology Excellent equipment and PACS
  technology Medical records easy to use Stable
  environment conducive for learning Attendings
  are professional and easy to work with
• Yikes
• We cover outside imaging centers to subsidize
  staff incomes

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Discussion

• AFIP
• Loss of stipend, making cost of attending
  prohibitive
• Funding received likely will be affected by
  change to 4 week program
• Several programs will not send residents to the
  AFIP starting this year
• Our chair is very committed to AFIP, but
  obviously, how many years can this last?

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Discussion

• Call
• 50 with gt10 weeks of NF during residency
• 41 with gt75 additional in-house overnight call
  shifts
• Decreased elective time
• Often unable to attend didactic conferences
• Expected to increase due to DRA and ACGME
  changes Current increases result of volume
• More moonlighting options for overflow studies?
• Decreased home call compared to 2005
• Resident teleradiology?

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Discussion

• ACGME Program Requirements
• Most of the concerns refer to R1 call restriction
• Requiring a resident to have at least a 1 month
  rotation on the modality/section in which they
  will be taking call makes more sense than not
  allowing a resident to take any independent call
  throughout the first year. After having been in
  the program for one year, they may not have any
  more exposure to these modalities than they had
  at the 6 month point.
• We have a high volume of trauma at our hospital.
  It will be very difficult for residents to start
  call in July- the peak of trauma season- for
  little added benefit of a few more months of
  training.

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Discussion

• ACGME Program Requirements (contd)
• Proposed changes of restricting the R1 call
  responsibilities will be detrimental to resident
  education. What an R1 learns by taking weekend
  and overnight call during the second half of
  their first year cannot be reproduced or replaced
  by any other study tool.
• Early exposure to independent interpretation and
  interactions with referring physicians is crucial
  to resident education and developing the skills
  needed to excel as a radiologist in the real
  world.

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Discussion

• Academics vs. Private Practice
• 35 of respondents entering academics
• Higher than average due to selection bias?
• listed as primary reason for entering private
  practice
• Better retirement savings plans for residents and
  staff
• Loan repayment programs
• Monetary incentive programs to encourage academic
  careers
• Teaching interest listed as primary reason for
  entering academic practice
• Majority of chiefly duties are administrative
• Consider more teaching opportunities, involvement
  in curriculum development, academic days and
  teaching electives

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Thank You