Since its approval in 2015, the integrated IR residency has become one of the most competitive specialties a medical student can apply to, with just 0.66 positions available per applicant in 2018. However, exposing medical students to IR has traditionally been difficult, given the lack of IR-focused lectures or rotations at most medical schools. Having a home IR program is crucial to exposing students to the field, as the program serves as a vector through which students can connect with faculty mentors, participate in IR rotations and become involved in research projects.
Osteopathic medical students (DOs) and international medical graduates (IMGs) are particularly disadvantaged, given that all IR residency programs are affiliated with MD-granting institutions. Interestingly, this deficit in exposure for DO and IMG students has historically resulted in some sort of compensation in the students’ residency application. For example, in the 2020 match, DO students who successfully matched into IR outperformed their U.S. MD counterparts on the U.S. Medical Licensing Exam (USMLE) Step 1 by an average of 5 points, while non-U.S. IMG students who matched into IR had significantly more research accomplishments than both MD or DO students.
However, the COVID-19 pandemic disrupted nearly every aspect of medical education. Medical students were removed from clinical rotation sites and subinternships at other institutions, as well as research labs due to travel restrictions. Moreover, the USMLE and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) were delayed due to test center closure. This posed a challenging, novel scenario for medical students interested in pursuing IR, given that their source of letters of recommendation and research and networking opportunities were no longer available. How would students and the world of IR adapt?
It turns out, quite well. With the advent of online meetings such as SIR 2020 and SIR 2021, as well as virtual medical student symposia, such as the one hosted by the Icahn School of Medicine at Mount Sinai, there was no shortage of opportunities for medical students to learn more about IR. Additional opportunities for involvement were provided through the Medical Student Council of the SIR Resident, Fellow and Medical Student (RFS) Section. These, in addition to the virtual IR rotations held by multiple institutions, allowed as close to “hands-on” experience as possible.
A recent survey of medical students interested in IR conducted by our research team demonstrated that 88% of all respondents reported involvement in online educational events during the pandemic. 32% of all respondents reported involvement in the online projects conducted by the RFS, while only 13% were able to participate in an in-person IR rotation. Students with home IR residency programs that participated in the survey were more likely to have earlier exposure to radiology through a core clerkship, be able to participate in an in-person IR rotation and partake in IR research at their institution. Respondents with home IR programs were also less likely to perceive COVID-19 as a negative factor for matching. Of note, all respondents with home IR programs were U.S. MD students.
The authors encourage the continued use of novel solutions to allow all students to demonstrate their candidacy. Virtual rotations should continue to be offered at more programs to increase student involvement and exposure to the field, as well as to the faculty and residents at specific institutions. A robust and standardized virtual IR elective curriculum can integrate opportunities for the rotator to shine, either during case presentations or didactic sessions, and offer students without a home IR department a potential source for a letter of recommendation. Other avenues to explore include further expanding the IR mentor match and integrating it with a research project match, so students without home IR departments still have access to research opportunities.
Medical students with home IR residency programs are more likely to have opportunities to engage in IR related activities, such as research, rotations and access to mentors in the field. Students without home programs, particularly those from DO or IMG backgrounds, are disadvantaged in the match as a result, which has especially been highlighted during the pandemic. As the world works toward the post pandemic era, novel solutions to ameliorate these disparities should continue to be explored and integrated to minimize bias in the IR residency application process in future years.
