Characterizing the Variety of Call Structures Across Canadian Diagnostic Radiology Postgraduate Medical Education Programs

Introduction

Canadian Diagnostic Radiology (DR) postgraduate medical training (residency) requires residents to independently cover after-hours imaging interpretation (call) as part of the formal curriculum. Increasing volumes and complexity in medical imaging, due to advancements in clinical medicine, diagnostic capability, and available treatments, have led to rising demands on call.^1,2 This has resulted in increasing resident burnout rates nationwide.^3-5 Resident Doctors of Canada reported that despite a slight decrease in number of hours worked weekly from the years 2018 to 2020, residents reported no significant change in burnout (51.9% to 51.6%, respectively). ⁶

Despite this established impact on resident wellness, there is paucity of publicly available information call structures at Canadian institutions. This lack of transparency inherently limits inter-program collaboration, hindering the ability of a program to learn from another’s experience. Furthermore, access to this information may facilitate advocacy efforts and contribute to standardizing call expectations across intuitions for equitable residency training.

A group of DR residents, belonging to the resident sections of the Canadian Association of Radiologists and Canadian Association for Interventional Radiology, created a survey to tabulate call structure data for all Canadian DR residency programs. This initiative will aid in creating an online database to be updated on a yearly basis and made available to all Canadian DR residency programs.

Methods

After obtaining research ethics board approval, a Google Forms questionnaire was distributed in October 2022 to representative residents at each of the 16 Canadian DR residency programs. All data were received and tabulated by December 2022.

The questionnaire included long and short answer questions pertaining to:

• Institution: affiliated university and hospitals, city and catchment size, resident body demographics.

• Call structure: shift type and length, start/end of independent call, ability for home call/remote access.

• Call responsibilities: modalities covered, procedural responsibilities, preliminary report requirements, protocoling responsibilities.

• Call support: attending, fellow, and technologist(s).

• Preparation for call: dedicated resources, “buddy call” system.

• Pre- and post-call: protected pre-call time, post-call review process, call performance evaluation.

Results

The data collected reflect call structures at all 16 Canadian DR residency programs as of December 2022. It is evident that 12/16 (75%) programs have a call structure that may require residents to work continuously for ≥24 hours, which includes a mixture of time spent during the regular workday and/or on-call hours (Figure 1). Three of these programs require residents to stay post-call, in addition to the 24 hours, to review overnight studies with attendings, further increasing the total number of continuous hours which comprise a single shift (Figure 1). Nine (56%) programs require residents to produce full reports during on-call hours (Figure 1). Regarding on-call support, only a single institution provides direct in-house attending support for all resident call shifts and eight (50%) programs require residents to perform ultrasound scanning (Figure 2).

Figure 1.

Work length and select call responsibilities from all 16 Canadian DR residency programs. UBC: University of British Columbia; UofA: University of Alberta; UofC: University of Calgary; UofS: University of Saskatchewan; UM: University of Manitoba; UWO: Western University; Mac: McMaster University; UofT: University of Toronto; QU: Queen’s University; UO: University of Ottawa; MU: McGill University; UdeM: Université de Montréal; UdeS: Université de Sherbrooke; UL: Université Laval; Dal: Dalhousie University; MUN: Memorial University of Newfoundland.

Figure 2.

Select call supports at all 16 Canadian DR residency programs. UBC: University of British Columbia; UofA: University of Alberta; UofC: University of Calgary; UofS: University of Saskatchewan; UM: University of Manitoba; UWO: Western University; Mac: McMaster University; UofT: University of Toronto; QU: Queen’s University; UO: University of Ottawa; MU: McGill University; UdeM: Université de Montréal; UdeS: Université de Sherbrooke; UL: Université Laval; Dal: Dalhousie University; MUN: Memorial University of Newfoundland.

Discussion

There is significant heterogeneity across Canadian DR resident call structures. Notably, twelve (75%) programs have a call structure that may require residents to work continuously for ≥24 hours, of which three programs also require residents to stay post-call for review. It is reasonable to infer that these factors may contribute to resident burnout, as suggested by prior literature.^3-6 These call structure data will serve as a referenceable resource for Canadian DR residency programs to help identify areas of potential change and improvement at their respective institutions. Individual programs would need to consider local case volumes and complexity and departmental structure when considering call changes. Future research directions include investigating the use of these data to support call reformatting and evaluating resident satisfaction after the implementation of new call structure strategies.