Trainee Perspectives on Breast Imaging Training during COVID-19: Where We Are Now.

The first documented case of SARS-CoV-2 in the United States occurred in January of 2020 [1], and by March of 2020 the World Health Organization declared a global pandemic [2]. Hospitals and facilities deferred elective patient visits to reduce exposure and virus transmission and to conserve medical resources including personal protective equipment. Position statements from multiple societies suggested to “postpone all breast screening exams (to include screening mammography, ultrasound, and MRI) effective immediately” [3, 4]. Diagnostic breast imaging cases were triaged and were often deferred, delayed, or cancelled, depending on the pre-test probability of disease, institution guidelines, and patient preference. A predictive model from the National Cancer Institute following the effect of COVID-19 on screening showed that an anticipated 10,000 excess deaths could be expected from breast and colorectal cancers, with the majority of these deaths occurring within two years [5]. As we work towards recovery and reestablishing screening, we will also need to be mindful of the effect of pandemic on our radiology trainees. COVID-19 has undoubtedly affected the way that curriculum is taught and received with many programs relegated to a virtual curriculum [6]. The reported effects of this shift in education style varied greatly with those residents closer to certifying exams and transition to practice being most affected. To counteract this change, the Accreditation Council for Graduate Medical Education set out a framework to prioritize learning based on different levels of restrictions imposed [7]. These frameworks consisted of three stages; stage 1 – “Business as Usual”, 2 – “Increased Clinical Demands” and 3 – “Pandemic Emergency Status” [7], to provide guidance and resources in maintaining resident education while balancing ongoing disaster preparedness and safety of trainees. As on-site personnel decreased to provide social distancing, institutions shifted to remote work and training. These changes, while met with enthusiasm [6], may have had a negative impact on education as compared with traditional face-to-face teaching and procedural skills training. Programs were required to rapidly integrate with new technology to continue to teach, sometimes without necessarily providing adequate training in use of videoconference software. While online learning may be more feasible in certain specialties, we wonder if others, such as breast imaging, will be more detrimentally affected, due to the requirements for case volume and hands-on training in procedural skills. The significant volume drop in imaging resulted in a considerable decrease in opportunities for learners. The altered training experience is multi-factorial, affecting many facets of resident training. We wanted to look at the potential learning and training gaps that occurred over 2020. As such, we surveyed our various trainee editorial boards at the Radiological Society of North America (Radiology, Radiology: Imaging Cancer, Radiology: Artificial Intelligence, and RadioGraphics) from academic programs across the United States, Canada, and Brazil to assess the impact of COVID-19 on their respective breast radiology rotations and measures to compensate for this. We write this piece in December 2020, to bring together a snapshot of how the pandemic has impacted breast imaging and trainees based on responses to the following questions.