RESUMO
The replacement of the ABR in-person oral examination with the DR certifying examination affected approximately 15,000 radiologists, spanning from 2013 to 2027. This decision was motivated by better aligning with the timing of other American Board of Medical Specialty (ABMS) members, more closely reflecting real-world practice of radiology and narrowing training geared towards the trainee's subspecialty preference. However, in retrospect, this change may have subtracted from the quality and value of diagnostic radiology training as a whole with the de-emphasis on competence in general radiology, communication skills, and cognitive reasoning. In this paper, the authors lay out a blueprint necessary in order to rewind the clock of how diagnostic radiology programs can prepare their trainees for the new DR oral examination. Such a change will require substantial redactions affecting all designations, including radiology faculty, education teams, departmental leadership, academic institutions, ACGME, and ABR. The authors believe that implementing these modifications will not only effectively equip radiology candidates for the new DR oral examination but will also augment the significance of radiologists as indispensable members of multidisciplinary teams. The authors also outline the challenges that could emerge from these changes and speculate on the anticipated role of AI in future oral board examinations.
RESUMO
Study Objective: Pain management in emergency department (ED) patients is challenging. Although both pharmacological and nonpharmacological therapies exist, they are often suboptimal. Immersive virtual reality (VR) uses distraction and possible other methods to reduce perceptions of pain. The purpose of the study is to evaluate the usability and acceptability of VR applications in ED patients by assessing patient-reported changes in pain, anger, and anxiety levels.Methods: This is a prospective cohort study at a single academic urban tertiary care center among ED patients with a pain score ≥3 on a numeric rating scale (0-10 integers) for any reason. Patients with stroke, epilepsy, dementia, or other diseases that may prevent use of VR were excluded. Enrolled patients in the intervention cohort spent 20 min using VR applications. A paired t test was used to analyze the change of pain, anger, and anxiety scores between pre- and postintervention. Analysis of variance and linear regression were used to assess the impact of other subject variables (including gender, age, race, and education) on pre-post intervention changes.Results: One hundred (N = 100) patients were enrolled in this study and 93 experienced the VR intervention. Of these, 57 (61.3%) were women, and mean age was 38 ± 14. Mean anger (2.28 ± 0.8 to 1.92 ± 0.7, p < 0.0001), anxiety (2.06 ± 0.8 to 1.81 ± 0.8, p < 0.0001), and pain (7.16 ± 2.5 to 6.49 ± 2.7, p < 0.0001) levels dropped significantly from pre- to postintervention. Outcomes of the VR intervention were impacted by subject variables, including education and ethnicity. Pain (1.86 ± 3.3, p = 0.03) and anger (1.03 ± 1.4, p = 0.02) levels dropped most for those with less than high school education. Linear regression analysis revealed that patients with higher levels of health/quality of life (QOL) had larger mean drop per unit predictor for anger (0.29 [0.09], p = 0.0013) and anxiety (0.22 [0.07], p = 0.001).Conclusions: VR applications are feasible for ED patients and may lead to reduced pain, anger, and anxiety levels. These outcomes are affected by subject ethnicity, educational status, and health/QOL although independent of the chief complaint.
