Evidence for an adverse impact of remote readouts on radiology resident productivity: Implications for training and clinical practice

After their rapid adoption at the onset of the coronavirus pandemic, remote case reviews (remote readouts) between diagnostic radiology residents and their attendings have persisted in an increasingly remote workforce, despite relaxing social distancing guidelines. Our objective was to evaluate the impact of the transition to remote readouts on resident case volumes after the recovery of institutional volumes. We tabulated radiology reports co-authored by first-to-third-year radiology residents (R1-R3) between July 1 and December 31 of the first pandemic year, 2020, and compared to the prior two pre-pandemic years. Half-years were analyzed because institutional volumes recovered by July 2020. Resident volumes were normalized to rotations, which were in divisions categorized by the location of the supervising faculty during the pandemic period; in ’remote’ divisions, all faculty worked off-site, whereas ’hybrid’ divisions had a mix of attendings working on-site and remotely. All residents worked on-site. Data analysis was performed with Student’s t test and multivariate linear regression. The largest drops in total case volume occurred in the two remote divisions (38% [6,086 to 3,788], and 26% [11,046 to 8,149]). None of the hybrid divisions with both in-person and remote supervision decreased by more than 5%. With multivariate regression, a resident assigned to a standardized remote rotation in 2020 would complete 32% (253 to 172) fewer studies than in identical pre-pandemic rotations (coefficent of −81.6, p = .005) but would be similar for hybrid rotations. R1 residents would be expected to interpret 40% fewer (180 to 108) cases on remote rotations during the pandemic (coefficient of −72.3, p = .007). No significant effect was seen for R2 or R3 residents (p = .099 and p = .29, respectively). Radiology residents interpreted fewer studies during remote rotations than on hybrid rotations that included in-person readouts. As resident case volume is correlated with clinical performance and board pass rate, monitoring the readout model for downstream educational effects is essential. Until evidence shows that educational outcomes remain unchanged, radiology residencies may wish to preserve in-person resident readouts, particularly for junior residents.Author summary: The rapid adoption and continued prevalence of remote work following the coronavirus-19 pandemic has profoundly impacted medical practice and resident training. The shift has particularly affected diagnostic radiology, which is amenable to remote work but is also traditionally centered around in-person, workstation-based case reviews (readouts) between residents and attendings. However, the impact of remote readouts on resident productivity remains largely unexplored. Our study investigates resident case volumes during the pandemic, after the recovery of institutional volumes (July to December 2020) and compares the volumes to same period in three preceding pre-pandemic years. Our study shows a substantial decrease in resident case volumes when working in divisions where attending faculty worked remotely, with the most pronounced impact on first-year residents. On the other hand, ’hybrid’ divisions, with a mix of on-site and off-site attendings, maintained similar resident case volumes to pre-pandemic levels. Given the correlation of case volumes with clinical and academic performance, our findings suggest monitoring for unintended consequences on radiology resident educational outcomes.