Special J.

Bruce

Hillman,

MD

#{149} Charles

E. Putman,

MD

Fostering Research Recommendations Summit Meeting’ At the annual Radiology Summit Meeting sponsored by the Intersociety Commission of the American College

of Radiology,

leaders

of U.S.

and

Canadian radiologic organizations met in part to discuss ways to improve radiology research. Support by radiology departments and radiologic organizations is currently not sufficient to improve the research of the specialty. Five issues of central im-

are (a) the need for a definition of radiology research, (b) a lack of financial resources, (c) a lack of mentors,

portance

to improving

research

(d) hesitancy to embark career, and (e) conflicts cians and researchers.

on a research between cliniThe adoption

of 31 recommendations regarding these five issues was urged.

by Radiologists: ofthe 1991

T

Radiology Summit Meeting is an annual event sponsored by the Intensociety Commission of the American College of Radiology. The purpose of the Summit is to bring togethen for 3 days the leaders of all of the U.S. and Canadian radiologic onganizations to discuss preselected topics of common interest and perceived importance. This year, the Summit attracted representatives of

researchers

39 of the

ploys with the powerful imaging tools available to investigate physiologic and basic biologic processes (8-10). The Summit discussion group re-

HE

Radiology

1992;

and

radiologists,

41 member

Asheville,

North

the

dealing formed

to

Carolina.

outcome

of the

with improving by radiologists.

Research

182:315-318

organizations

Representatives were divided into two groups; the groups, each led by moderators, were assigned to discuss either (a) ways to improve the research performed by radiologists or (b) standands and recertification for radiologic practice. This presentation details

Index terms: Radiology research #{149} Special reports

is the

radiology. edges

The “his”

strikes,

“eccentric

presence,

pays

tance.

The

discussions

research

specialty

out at appropriate and admired, and,

uncle”

brings

times when

of

to “his”

however,

tion

From

the

Departments

of Radiology,

Univer-

ber 9, 1991; accepted September 18. Address reprint requests to B.J.H., Department of Radiology, University of Virginia Health Sciences Center, Box 170, Charlottesville, VA 22908. This article is also being published in the February 1992 issue of Investigative Radiologi,i. RSNA, 1992

to the

has

arisen

impor-

always

at arm’s length, clinical concerns

specialty.

This

in the context

improve

the

quality

sis-driven,

and

sponsible

for

too

the

infrequently

topic

em-

of improving

research by radiologists reviewed the literature cited in the above paragraph before the meeting. The group agreed that research has important intrinsic value both to the specialty and to individual radiologists by its relation to (a) improving radiologic practice tients,

for referring and radiologists;

practices

and

clinicians,

pa-

(b) validating developing new the relation-

services; (c) furthering ship among radiology, other clinical specialties, and the basic sciences;

of organized radiology. Nevertheless, there has recently been a growing appreciation of the importance of research

and

of their research (4,5). It is evident, however, that support of radiology research by individual radiology departments and nadiologic organizations, while improving, still falls well below the level required to improve the research of the specialty (6,7). In particular, radiology “research” is too often descriptive, too rarely hypothe-

current

“him”

to be viewed the mood

homage research greater,

pen-

acknowl-

specialty,

has treated outside the

sity of Arizona, Tucson (B.J.H.), and Duke University, Durham, NC (C.E.P.). Received Septem-

Report

realiza-

of the

(d) attracting est and most

and retaining the brighttalented young persons specialty; (e) improving the

to our status and nationally

credibility of radiology, and internationally; and

(I) retaining the

radiologists’ privileges practice of their specialty. During the sessions, participants

addressed

how

radiology

depart-

growing importance of technology assessment to medical practice and reimbursement for services, and the recognition of how high-quality research might enhance the identity of radiology.

ments, radiologic organizations, and the radiology community at large might support specific initiatives to improve the research performed by radiologists. The group agreed that five issues were of central importance

Previous problems

in this

searchers researchers recently,

research confronting

has identified clinician-re-

in general and in particular some empirical

detailed the steps that to increase the number

the

radiologist(1-3). More studies have

might be taken of radiologist-

regard:

Abbreviations: Ray Society, Radiologists,

North

(a) the

to

need

for

a defi-

ARRS AUR RSNA

=

= American Roentgen Association of University an Radiological Society of

America.

315

nition of what constitutes radiology research; (b) a lack of financial nesources that may grow more severe

with

reduced

clinical

for academic city of mentors

as broadly

reimbursements

departments; who are

possible

as

to include

(a) a tra-

councils and study sections, and develop requests for proposals for which radiologists can compete successfully. Efforts should continue toward the development of a separate institute for radiology.

description of techniques and their applications; (b) scientific technology assessment, including the assessment of patient outcomes; (c) the application of ditional

(c) a pauthemselves

well trained in research in most academic departments; (d) a hesitancy among many of the most talented trainees and young faculty to embank on research careers; and (e) conflicts between the role of clinicians and that of researchers in academic departments.

modalities and techniques to inbiologic and molecular proand (d) the investigation of social,

imaging

vestigate cesses;

political,

economic,

issues sphere

and

organizational

related to radiology of medicine.

6. Radiology focus ogy.

on

and

research

disease

should

processes

the

broader

more

than

often

technol-

support

ing Financial

Resources

for Research

External Is Radiology

Recent most

Research?

reports

have

publications

literature

shown

in the

that

radiology

are descriptions

of tech-

niques on of patient cohorts submitted to an imaging modality (8,11-13). Al-

though such reports the early development ogy and to the usual conditions,

criticized

are essential to of a technol-

understanding radiology

of unhas been

for the failure

of such

writ-

ings to generate hypotheses that are submitted to more rigorous technology assessment. Critics of radiology research point to the mistaken impressions that might result from the

continued

publication

of descriptive

studies and the related possible misapplication of technology. bunsement agencies are moving

wand

tying

reimbursement

vice to scientific efficacy. 1. Trainees

receive

costly Reimto-

for a ser-

demonstrations

and

training

young

of its

researchers

in the methods

must

of scien-

studies

more

feasible

3. Funding

and

agencies

both

outside radiology must the value of technology ducing

expenditures

health

tient

more quire

and

the

to be more

In addition,

This

perception

search

of their

and acre-

in dis-

results. basic

may

by radiolo-

in part

that the

science

in radiology

particularly

is not

be

should

objective

too little

departments,

recently organizations

be related

this

type

purview

to

of ne-

Institutes

of Health.

Radio-

the specialty

are

There

most

radiology

by individual from clinical able for this reimbursement

gressively

must

better

existing

funds,

research

should

be

defined

also should

while by

more

philanthropic

the

nadiologic

12. In recognition

tra-

sources of research funds and new resources. With respect

to underused

role.

the endowfor accom-

support

of ne-

organizations

it is evi-

of the

their educational on academicians

ag-

support

recently has improved, there much more that can be done.

funded

exploit

is play-

efficiently.

explore

Finally, search

academic departments revenues. Funds availpurpose will diminish as for radiology services

decreases. Radiologists

ditional develop

is still

more

of research, possibly through ment of programs or chairs plished investigators.

is a new

research

research

important

11. Departments

for the and the The Coninstrumenan intramuNational

division of diagnostic and therapeutic extramural grant interests at the National Cancer Institute. Despite this,

is still

dependence

and scientific and academic

of

programs depart-

ments, the seminal radiologic organizations-particularly the Radiological Society of North America (RSNA) and American Roentgen Ray Society (ARRS)-

should

consider

tributions research

significantly

greater

con-

to academic development and programs. These could be fi-

nanced

by setting

that radiologists capable of competing for grants too often do not ap-

revenue mercial

derived from payments for cornspace at meetings, increasing

ply.

membership

dent

This

may

radiologists

occur

in part

are unaware

because

of information

to the availabil-

might

pertaining funds

apply.

organized regularly, departments.

for

which

This clearinghouse

chairmen

should

must

be

more

Mentors vig-

Also with regard to traditional funding sources, radiology must continue to work toward a greater pnesence at the National Institutes of Health, Agency for Health Care Policy and Research, and National Science Foundation.

“campus,”

must

assume

extramural

promote

their

rathe

atives.

orously encourage their faculty to apply for external funding and provide sufficient rewards for successful efforts.

in the

higher

radiologists

to be user-friendly, updated and distributed to all academic

8. Department

or charging

of

models already established for funding radiology research and develop new initi-

of Radiology clearinghouse

of grant

a percentage

meeting

7. The American College should develop a national ity

dues,

aside

registration fees. 13. Subspecialty societies and other diologic organizations should emulate

of receptive

of funding.

9. Radiologists

#{149} Radiology

increased. currently

developing special funds training of new researchers conduct of their research. joint Committee has been tal in the development of ral research center at the

positions

316

has

ne-

of radiolo-

gists. 5. Radiology

for radiology

representativeness,

is performed

the

to better should

and

validity,

gists.

pa-

in the assessment

and generalizability

research

and aware of in re-

improving

of manuscripts

authors

cussing

within

be made assessment

genre of research. journal editors

rigorous

assessthese

expensive.

and be encouraged

support this 4. Radiology ceptance

less

search logic

sources

technology assessment. 2. New methods of technology ment must be developed to make tific

funding

of radiology

an increasingly

10. Departments should encourage closer ties with industry, both to facilitate their own research goals and to advance

RECOMMENDATIONS What

These goals are best accomplished through the continued activities of the Conjoint Committee with the renewed and expanded support of other radiologic organizations. Newer sources of research funding also must be developed. Commercial

important program

own

selection

There is a concern for how nadiologist-researchers might be better trained if it is conceded that relatively few current academic radiologists have themselves been well trained in research. A number of models are presented for consideration: 14. Departments should develop better interaction between their own PhD researchers and radiologists interested in performing research. 15. Departments should consider establishing research training relationships with other clinical and basic science de-

pantments

on

to

for Research

feasible,

in their own with

other

institutions

or, if

institutions.

February

1992

16. Talented, interested persons should be encouraged to participate in the new intramural research training program at

a sufficient

number

of persons

phisticated

research

expertise

the

mentors

National Institutes 17. Consideration

of Health. should be given

development of specialized research training centers tutions.

These

petitively,

might

of radiology 18. There

port

materials

be

aspects publications

the

shop, such

annual

Grantsmanship

sity Radiologists tion to Research search

in-

Work-

(AUR)-ARRS Introducprogram, and AUR re-

grams.

trainees

choose

a career

research. with the

This phenomenon experience of other

ties

have

that

been

more

in

is at odds special-

successful

in

recruiting researchers. The difficulties in developing radiology researchers relate to their efficient identification, the support structures available in departments, a paucity of willing Capable mentors, the flexibility of depantments

ented

in offering

programs,

toward pantments,

able

research

has

identified

seem

to the selection

Additional

or her

advocate

might

training the

include

context

clinical

to develop

experimental

their

Those

who

want

undergo

for

of trainees. might

identify

themselves as potential researchers point in their training or careers, still valuable to identify potential

ers as early training

as possible

and

to provide

protected

their

21. Departments

should

port structures

at any but it is research-

them

environment

will best encourage

develop

that will facilitate

sup-

by trainees and should in-

dude, but not necessarily be limited to, pilot funding, space, secretarial support, with tistics, writing.

facilities,

expertise grant

182

resource

persons

in experimental design, requests, and manuscript

22. Trainees must selves or be assigned

Volume

and

identify for thema mentor. Given

#{149} Number

and biostatisresearch

extensive

training.

should

that

recognize

careers

should make spewomen to enter

and foster

2

has

shown

that

a successful

those

pursuing

ognize

that

in the deresearch time

significant

research research

time

invest Past

develop-

unencumbered

is the most

with

their

career. In turn, careers must nec-

afforded

departments

is not

aggressively

pursue

free,

to do

correlate

them

and

external

by

they

sta-

that

depart-

improving

un-

should

provide

an

at-

that not all faculty will

play

the

Rather,

same

members

roles

individual

or

in the

faculty

contribute

de-

mem-

to the

clinical, teaching, administrative, and research missions. 31. Department chairmen should consider whether different incentives and re-

wards might be appropriate to encourage excellence in achieving each of these missions. Further, chairmen should foster understanding among faculty members of the equivalent importance of their contnibutions.

CONCLUSIONS Discussion

participants

agreed

that

efforts to improve the research performed by radiologists-both by increasing the number of competent radiologist-researchers and improving the quality of their research-are important for strengthening the specialty

of radiology.

While

participants

recognized the potential difficulties inherent in implementing the recommendations described in this report, they urged their adoption by nadiology

departments,

tions, and munity.

the U

radiologic

general

onganiza-

radiologic

com-

their

References

should

funding.

1.

that

the per-

faculty,

30. Departments

the

development.

formance of research both their mentors. This support

computer

research-

to conduct

more

Departments

research ment.

be

procedures

trainees

an

or the to a

other

of reducing and more

mosphere that portrays the positive aspects of a research career. There should be

partment.

program,

their re-

of the value of research, and good role models for trainees.

bers may differentially

training, training

design,

research. Departments cial efforts to encourage

of research

should

with

as a means researchers

oriented

derstanding establishing

26. To improve understanding of the value and methods of research, all trainees and faculty should undergo basic instruclion in critical reading of the medical liter-

27.

that

clinically

encourage

to perform

in collaboration

ment members conffict between

trainees

of

should

researchers

recognition

trainees

well-trained

29. Departments established

ens.

research

Radiology

as

fellowship.

sources

ing in research. In addition, there is often subtle but real disapproval by more clinically oriented faculty of the contributions of persons who spend more of their time in research. These conditions are perceived by trainees and young faculty members who might be discouraged from panticipating in research.

search

25. Some departments should consider specializing in research, accepting only candidates who agree to an additional year or more of research training and focusing on the provision of the needed re-

this

into

1 year

of a 4-year

28. Departments must velopment of researchers.

20.

be recognized

for selected

performed in this area. Departments with the resources to foster research careers should consider more formally integrating selection

de-

for advance-

additional year of research linking of extensive research

should

some

factors

research

information

in the

women represent a particularly underused resource for improving radiology

and attitudinal

related

This

within

tics.

deavail-

training.

experimental careers.

as his

research

ature,

attitudes

in academic time and funds

for research

19. Recent

reseanch-ori-

perceived

researchers and

act

must facilitate the reactivities of the trainee

24. Departments should consider flexibility within their programs to allow selected trainees to pursue research pro-

Trainees

few

identify-

that can be learned. Radiologic organizations should encourage the networking of mentors at their meetings to facilitate the exchange of ideas on how to be better mentors.

Despite the oversubscription of outstanding applicants to radiology programs-and the resultant excellent quality of radiology trainees-relatively

for

a talent

at symposia of Univer-

symposia.

Recruiting

departments,

and favorable considerations ment. 23. Mentorship should

of perform-

the materials presented as the RSNA-Association

radiology responsible

partment. Mentors should receive tangible rewards for the efforts they expend in this role, in the forms of time to direct research

sup-

might

be

sonot be

ing resource persons in their own or other departments that will help in the technical training of the individual. Just as impor-

and

of instructive

Such

in some must

tant, the mentor search and other

corn-

and suconsisting

organizational

publication

concerning

research.

dude

designated

from the region.

should

for regular

ing

be

scientists

to the

“regional” at existing insti-

funded extramurally, by a board of directors

pervised

available

with may

2.

The Risks of a Research Career the Conflicting Roles of Faculty Academics

and in

A common perception of a career in research is that it offers greater risk and less stability than private practice on an academic career focusing on teaching or clinical work. To some extent, this is the case. The risks of instability, however, can be ameliorated by obtaining appropriate train-

3.

4.

Hillman BJ. The inadequacy in the number of physician researchers. Invest Radiol 1985; 20:767-771. Wyngaarden JB. The clinical investigator as an endangered species. N Engl J Med 1979; 301:1254-1259. BickelJW, Sherman CR, Ferguson J, Baker L, Morgan TE. The role of M.D-Ph.D. training in increasing the supply of physician scientists. N EnglJ Med 1981; 304: 1265-1268. Hillman BJ, Fajardo LL, Witzke DB, Carde-

nas D, Inon M, Fulginiti

5.

JV.

Factors

influ-

encing radiologists to choose research careers. Invest Radiol 1989; 24:842-848. Hillman BJ, Fajardo LL, Witzke DB, Cardenas D, Irion M, Fulginiti JV. Factors influencing the success of academic radiologists

Radiology

#{149} 317

6.

in publishing 24:849-854. Virapongse

eau BS, Staab

7.

8.

318

research.

Invest

C, Emerson

EV.

Radiol

5, Li KCP,

Research

Martin-

resources

9.

in

academic radiology. Radiology 1990; 175: 247-251. Hilman BJ, Witzke DB, Fajardo LL, Fulginiti JV. Research and research training in academic radiology departments. Invest Radiol 1990; 25:587-590. Holman BL. The research that radiolo-

#{149} Radiology

gists do: perspective based on a survey of the literature. Radiology 1990; 176:329-332.

1989;

Effmann

ogists:

10.

11.

EL.

Research

by pediatric

past accomplishments

opportunities. 361. Northway of diagnostic

Pediatr

Radiol

radiol-

evaluations 12.

and future 1987;

method limitation. Radiology 1989; 171: 873-875. Cooper LS, Chalmers TC, McCally M, BerrierJ, Sacks HS. The poor quality of early

resonance

established after the first decade? tern Med 1988; 108:402-424.

17:355-

WH. Research in departments radiology: a question of

of magnetic

ing. JAMA 1988; 259:3277-3280. Kent DL, Larson EB. Magnetic of the brain and spine: is clinical

13.

imagresonance efficacy

Ann In-

Beam CA, Sostman HD, Zheng JY. Status of clinical MR evaluations 1985-1988: baseline and design for further assessments. Radiology 1991; 180:265-270.

February

1992