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• W4313453873 abstract "The nearly 3 years since the onset of the coronavirus (COVID-19, or COVID) pandemic have led to changes in many parts of our world that may have otherwise taken decades to evolve. Whether we are speaking about people working remotely (in hybrid or full-time remote models) or the increase of remote conferences with a commensurate decrease of in-person meetings, there is little that has not been affected by the pandemic. The societal cost may be highest in terms of how education has changed—will the lack of in-person teaching lead to future shortcomings in the knowledge base of radiology trainees and other medical learners? Even at the level of how conference attendance is tracked, we have had to rethink our approach and make online resources available [1Kamel P. Brookmeyer C. Tang H. Solnes L. Lin C.T. Conference attendance tracking and evaluation in the era of virtual conferences.Acad Radiol. 2022; 29: S76-S81Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. It may be decades before we ultimately understand the impact of COVID on our trainees. However, as we now look at coming out of the pandemic, with a general return to normalcy in many aspects of our daily lives, it is of value to examine where we are with remote versus in-person meetings and conferences. As people think about “getting back to normal,” we should wonder if this is really the goal, and if going back to “business as usual,” circa February 2020, might be little more than the infamous “fighting the last war.” It is often stated that generals always “fight the last war,” which means that military strategy often focuses on what has happened rather than what will happen. We learn what worked best against the enemy in the prior conflict as well as the strategies that succeeded, and those approaches become the dogma. This concept has been suggested in various medical contexts, including a number of manuscripts that have specifically noted the opportunities and pitfalls associated with the postpandemic era [2Hachamovitch R. Soman P. ISCHEMIA Trial: are we still fighting the last war?.Circ Cardiovasc Imaging. 2021; 14e012319Crossref Scopus (4) Google Scholar, 3Goh G.X. Tan K. Ang B.S.P. Wang L.F. Tchoyoson Lim C.C. Neuroimaging in zoonotic outbreaks affecting the central nervous system: are we fighting the last war?.AJNR Am J Neuroradiol. 2020; 41: 1760-1777Crossref PubMed Scopus (4) Google Scholar, 4Bezruki A. Moon S. Post-covid reforms: can we avoid fighting the last war?.BMJ. 2021; 373: 1184Crossref Scopus (1) Google Scholar]. The idea was eloquently described in Joe Haldeman’s classic science fiction novel The Forever War [5Wiltsche H.A. The Forever War: understanding, science fiction, and thought experiments.Synthese. 2021; 198: 3675-3698Crossref PubMed Scopus (4) Google Scholar], in which relativistic travel and time dilation force humans to constantly re-evaluate their tactics relative to an alien race, never knowing how out-of-date their existing approaches might be. We should understand that, from the perspective of those who may be our learners, we may be oblivious to how out-of-date our methods are. In the postpandemic world, the “enemy” has changed and the old tactics may fail; our workplace has permanently changed and it will be to our detriment if we fail to recognize that fact. That is a poignant lesson for medicine and medical training. Although prepandemic, radiology training had changed over time, many aspects of the teaching process had remained constant. Morning and/or noon lectures remained a backbone of many training programs; such lectures were in-person and benefited from a real-time interaction between the lecturer and the learners. Side-by-side workstation learning was also key to imparting search patterns and practical considerations to trainees. Of note, onsite teaching is important for the education of residents, and this is particularly true for lower-level residents. In this regard, one study found that 52% of trainees reported that the use of remote workstations in academic radiology departments during the COVID-19 pandemic had negatively impacted resident education, with a significantly more pronounced impact on lower level residents [6Bass R.Z. Smith A.D. Langston M.C. Frazier M.B. Tridandapani S. Trainee and faculty perceptions of remote PACS workstations and next steps in a large US academic medical institution.Curr Probl Diagn Radiol. 2022; 51: 146-151Crossref PubMed Scopus (5) Google Scholar]. Those aspects of radiology that cannot be distilled into statistics and differential diagnoses must, necessarily, be taught via experience from the attending to the trainee. Regardless, we should ask why lectures need to be in-person and if, instead, lecture can be recorded and reviewed by trainees before conference. At our institution, we have long had a biweekly conference focused on CT teaching cases with the case discussions often including results from other cross-sectional imaging and pathology. That conference has served as a review of interesting cases for our diagnostic imaging faculty, with feedback on aspects of imaging that might be missed or might play a role in the interpretive approach. The average attendance in the prepandemic era was 10 to 12 faculty, with some faculty unable to attend because they were on nights or at remote service sites. Trainees had not been invited, in the interest of ensuring there would be coverage on all services even with the attendings at conference. However, the entire nature of the conference changed in the pandemic era, with attendance opened up to anyone who could log-on to a remote conference. As a result, attendance has ballooned to approximately 50 every week, with attendees including on-site faculty, off-site faculty, and trainees. The transition from an in-person conference to a virtual platform allowed for a much wider reach, with anyone sitting at a workstation or personal computer able to join. The conferences are also recorded. The switch to recording of lectures and availability of those lectures online addresses a number of important points, including keeping learners separated from each other to meet any future social distancing restrictions; allowing for the development of a library of lectures that can be reviewed as part of board review or self-study; and making lectures widely available to advance global health [7Haj-Mirzaian A. Sethi N. de Francesca B. Sahni S. Zaheer A. Web-based Radiology subspecialty training program: pilot feasibility and effectiveness analysis on Ethiopian radiologists.Acad Radiol. 2020; 27: 293-299Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar] and mitigate against health disparities. Outside of conferences, we also note how reviewing cases with residents and fellows in the reading room while sitting side-by-side has been minimized because of COVID-related restrictions; honestly, there are a number of forces playing into that, including faculty that prefer a remote working model and residents that enjoy the autonomy that comes with remote readouts. As a limitation, however, trainees and faculty perceive in-person learning more favorably than remote learning across a variety of domains, including overall enjoyment, interpersonal connection, ability to communicate, and concentration [8Heldt J.P. Agrawal A. Loeb R. et al.We're not sure we like it but we still want more: trainee and faculty perceptions of remote learning during the COVID-19 pandemic.Acad Psychiatry. 2021; 45: 598-602Crossref PubMed Scopus (14) Google Scholar]. There may be something truly irreplaceable in interactive teaching at the workstation, although as “older” attendings become more adept at the use of programs such as Zoom (Zoom Video Communications, San Jose, CA) and Teams (Microsoft, Inc., Redmond, WA), the drop-off from the in-person approach should be minimized. As of now, we do not know the answers to many of the questions regarding the future of radiology education. However, as Pereira et al recently noted, we are entering an era in which a generation of learners expect technology to be the core of their education [9Pereira S.W. Fishman E.K. Rowe S.P. The Future is now: how technology and entertainment are transforming education in the artificial intelligence era.J Am Coll Radiol. 2022; 19: 1077-1078Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. The artificial intelligence era combined with pressures from the pandemic have forced our hand and hastened the rollout of technology-based learning approaches. At the same time, technology can be used to promote in-person learning format owing to the use of interactive and engaging teaching tools such as audience response systems that are used during RSNA Diagnosis Live, flipped classroom techniques, and active learning strategies [10Awan O.A. Analysis of common innovative teaching methods used by radiology educators.Curr Probl Diagn Radiol. 2022; 51: 1-5Crossref PubMed Scopus (5) Google Scholar]. Going back to an in-person format for noon conferences at this point would sacrifice a large proportion of the audience. Expecting all readouts with residents and fellows to be in real-time at the same workstation is unlikely to ever be realistic again. Although it is natural to miss what we lost during the pandemic, it is also important to recognize the trends toward increased use of remote learning are a natural progression of what is allowed by technology. Had the pandemic not happened, our society likely would have still hedged towards increased use of remote conference attendance and remote readouts, although the pace of change may have been much slower. Our temptation to “fight the last war” and recapitulate our prepandemic experiences is misplaced. Radiology education is forever changed, and we should embrace that." @default.
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• W4313453873 title "Radiology Education and Training 2022–2032: Are We in Danger of Fighting Yesterday’s War?" @default.
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