This study aimed to evaluate the effect COVID-19 has had on radiology training throughout ESR member countries. The results of the survey demonstrated great variability within and between different countries and revealed that the pandemic significantly influenced supervision, teaching, examinations and the work environment of the participants. Importantly, the results showed that the outbreak has significantly impacted the quality of life of participants, affecting their health and their financial status.
Resident training was significantly affected over the course of the pandemic, with significant disruption to supervision. Almost half of our participants reported no access to online training and received limited or no feedback from their supervisors. Our results come to confirm the views of Alvin et al. [4] who foresaw that the current condition would be disadvantageous for supervision and proposed the application of remote meetings with supervisors to at least partly control the problem. A similar experience was reported from a Texas-based institution where interaction with supervising faculty has decreased either because of social distancing or because residents and fellows were deployed to other posts [3]. Our results show that the majority of trainees were not redeployed to other posts. Therefore, the effects on supervision could be mainly attributed to social distancing measures applied both for trainees and for their supervisors.
Theoretical radiology training during the outbreak has been primarily administered online. In some settings, this resulted in reduced resident learning time in contact with an experienced faculty member. A number of measures to electronically mitigate this problem have been proposed in literature such as adopting virtual readouts with the use of a camera so that senior radiologists can remotely supervise trainees [9]. Such proposals are hindered by the need to install costly hardware and PACS systems at the home office of young radiologists. However, the use of video call systems to host webinars and facilitate multidisciplinary team meetings has been proposed as a viable alternative [10]. At the same time, online learning enabled trainees to access the lectures held in other clinical institutions and created additional learning possibilities. Indeed, our participants reported a significant reliance on online education during the pandemic and the ESR and other radiology focused societies have enriched their webinar programs and modified the format of major conferences to facilitate the online dissemination of information while promoting social distancing. Such measures, however, cannot replace teaching for modalities that require patient contact (e.g. ultrasound and interventional procedures) [2] and cannot replace day-to-day supervision and case discussion with supervisors.
Exam delivery was disrupted to a variable extent across the countries of the participants, including where exams were cancelled for the whole duration of the outbreak. These changes have affected residents who were required to extend their training program and wait for qualifying exams. The core examination of the American Board of Radiology had been postponed for a significant time, delaying the process of graduation and posing hurdles for subsequent subspecialty training [4, 11]. Institutions like the EBR (European Board of Radiology) and the RCR (Royal College of Radiologists) have attempted to offer online proctored examinations as an alternative. The European Diploma in Radiology (EDiR) offered by the EBR stands as a viable alternative since it can be delivered by the local radiological societies and can also be delivered on-site for hospitals and institutions. In the past few months, several on-site EDiR e-examinations have been carried out, among others, in various cities in Croatia, France, Italy, Poland and countries outside Europe. Finally, the European Board of Radiology (EBR) has developed a software tool to conduct e-examinations in collaboration with the local national professional societies, scientific institutions and other speciality sections allowing them to organise their examinations locally for their residents. The first e-examinations were successfully held in September and October by the Consejo Mexicano de Radiología, allowing local residents to perform their board exams.
The well-being of young radiologists has been directly impacted by the SAR-CoV-2 outbreak. Approximately half of the participants reported that either themselves or their colleagues had been infected. In addition, some trainees were suspended, influencing their financial and psychological status and only half of them had access to mental health services. A recent study in the UK showed that 48% of radiology trainees wellbeing deteriorated during the pandemic [11] and trainees with ongoing student loans, health insurance and family-related financial obligations are expected to have their income reduced not only by the reduction in working hours [4] but also by the reduced reporting workload [4, 11] which could lead to delayed retirement and other financial hurdles. Potential solutions to this problem include offering paid leave to trainees who contract or become ill with COVID-19, to make sure that loan repayment can be extended and to make available mental health services for trainees with psychological struggles.
One limitation of our study is that the survey was not completed by residents in all ESR member countries. However, distribution of the survey was achieved through national radiological societies and the degree of participation was the maximum achievable given the ongoing pandemic situation. The size of the participant cohort was also affected by the voluntary nature of the survey. However, the validity of our results is indicated by abstract similarities with results presented from individual countries [11].