A national survey exploring UK trainees' perceptions, core training experience, and decisions to pursue advanced training in breast radiology

doi:10.1016/j.crad.2017.06.013

Clinical Radiology

Volume 72, Issue 11, November 2017, Pages 991.e1-991.e13

https://doi.org/10.1016/j.crad.2017.06.013 Get rights and content

Aim

To investigate UK radiology trainees’ perceptions of breast radiology and the factors that influenced their decision whether or not to choose breast radiology as an area of special interest.

Materials & methods

An online survey was compiled and distributed to all UK specialty trainees in clinical radiology via the Royal College of Radiologists Junior Radiologists’ Forum (JRF) regional representatives.

Results

There were 275 respondents, representing 22% of all UK radiology trainees. Responses were received from all regions. A significant factor identified in influencing whether or not trainees decide to pursue advanced training in breast radiology is the timing and quality of their initial core training experience. Specific positive aspects of breast radiology that were repeatedly identified included the high level of patient contact and frequent use of interventional procedures. Recurring negative aspects of breast radiology included isolation from general radiology and finding the subject matter boring.

Conclusion

Breast radiology faces a significant workforce shortfall that is predicted to worsen in the coming years. There has never been a greater need to recruit specialty trainees into this field, and action is urgently needed to help ensure the sustainability of breast services and drive further improvements to patient care. The findings from this survey should be regarded as a challenge to all breast radiologists to engage with trainees from an early stage in their training and to enthuse them with the many positive aspects of a career in breast radiology.

Introduction

Demand for the services of breast radiologists has never been higher. Breast cancer not only remains the most common cancer in the UK,¹ but the annual number of newly diagnosed female breast cancers has risen continually for the last 20 years.² With extension of the age range for the NHS Breast Screening Programme, and the requirement for all women presenting with breast symptoms to be assessed within 2 weeks,³ the workload of the breast radiologist continues to increase. Greater use of more complex imaging such as breast magnetic resonance imaging (MRI) for surgical treatment planning, high-risk cancer screening, and assessing response to neoadjuvant chemotherapy places further demand on breast radiologists’ time.

A critical problem in meeting this demand is the recognised shortage of breast radiologists in the UK, a situation that is expected to worsen significantly over the coming years. Although breast radiology is the largest area of special interest within general radiology, it faces the greatest workforce deficits.⁴ A survey of NHS Breast Screening Programme units and radiology departments carried out in 2015⁵ confirmed significant understaffing issues, showing that 25% of NHS Breast Screening Programme units operate with just one or two consultant radiologists with no cover for sickness or absence. There were 60 vacant consultant breast radiologist posts across the UK, representing around 13% of all substantive posts. Less than half of these were expected to be filled within the following 12 months. Moreover, 21% of breast radiologists are expected to retire by 2020, increasing to 38% by 2025, and 53% by 2030, which will have a severe impact on breast cancer screening and diagnosis unless these positions are filled.

These problems are further compounded by the recognition that too few breast radiologists are being trained.⁵ The standard clinical radiology specialty training programme within the UK comprises 3 years of core radiology training (ST1–3) followed by 2 years (ST4-5) of advanced (special interest) radiology training, allowing trainees to develop higher competences in a specific area(s).⁶ The exception to this is training in interventional radiology, which is currently the only formally recognised subspecialty within radiology, lasting for 6 years (ST6) and leading to a separate Certificate of Completion of Training (CCT). During ST1–3, all trainees are required to gain experience and basic competences across the core components of radiology, including breast radiology. Summative assessment of the core curriculum in breast radiology occurs in both parts A and B of the final Fellowship of the Royal College of Radiologists (FRCR) exam. During ST4-5, trainees spend dedicated time in their chosen area(s) of special interest and develop higher competences in preparation for work as a consultant.

In order to inform potential improvements in recruitment of trainees to breast radiology at ST4-5 level, the present study was undertaken to survey all UK radiology trainees regarding their perceptions of breast radiology and the factors that influenced their decision whether or not to choose breast radiology as an area of special interest.

Section snippets

Materials and methods

The survey was compiled on SurveyMonkey (www.surveymonkey.net) and distributed to UK specialty trainees in clinical radiology via the Royal College of Radiologists Junior Radiologists’ Forum (JRF) regional representatives. There were 35 questions in total (Electronic Supplementary Material Appendix S1), but not all were applicable to each respondent. “Page logic” was applied, automatically directing respondents to the most appropriate next question based on their response to the previous

Response rate

Overall 275 trainees completed the survey. In March 2016, during the time the survey was “live”, there were a total of 1,270 clinical radiology trainees in the UK (figure obtained from an enquiry to the Royal College of Radiologists), giving a response rate of 22%.

Demographics and working patterns

There was at least one response from each training region in the UK (Table 1). Overall, years ST1 through to ST5 were well represented (Fig 1). As expected, far fewer responses were obtained from those in ST6 as only a small

Discussion

The aim of this survey was to ascertain the factors that influence trainees’ decisions whether or not to pursue breast radiology and to try and identify ways in which recruitment to breast radiology may be improved in the future. The precise reasons underlying these are inevitably complex, and a survey of this type cannot provide all the answers, but it is intended that the data gathered will give an overview to inform further discussion regarding resolving the current workforce crisis in

Acknowledgements

The authors thank the British Society of Breast Radiology Executive Committee for their input and for providing financial support for the survey prizes. S.L. was funded by a National Institute for Health Research Clinical Lectureship. R.S. is supported with research funding from the National Institute for Health Research Cambridge Biomedical Research Centre.

References (7)

Cancer Research UK. Breast cancer statistics. Available at:...
National Cancer Intelligence Network. Cancer e-Atlas. Available at:...

There are more references available in the full text version of this article.

Cited by (1)

A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK
2022, Clinical Radiology
Citation Excerpt :
Similarly, looking at things from a different viewpoint, the proportion of trainees who stated they had no intention of pursuing breast radiology prior to their core rotation and still did not want to pursue it after completing it increased 1.5-fold when their rotation took place during pandemic (41%) compared to before it (27%), again suggesting that trainees' core breast rotation experience has the potential to positively influence career decisions towards breast radiology. The notion of trainees' core rotation experience influencing their decision to pursue higher breast training was also addressed in a previous survey of UK radiology trainees, where 17% of respondents had said their core rotation positively changed their mind to pursue breast radiology when they had not previously considered it.9 In fact having had a “positive experience during [their] core rotation” was one of the top reasons why trainees pursuing higher breast training had chosen to do so, second only to having a “good level of patient contact” and being “interested in the subject”.9
To investigate the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK from the perspective of trainees and new consultants.
A survey comprising 25 questions was distributed to UK radiology trainees via the regional Junior Radiologists Forum representatives under the auspices of the British Society of Breast Radiology (BSBR).
Sixty-nine eligible responses were received representing all UK training regions. Fifty-five per cent of respondents completing either a core or higher breast rotation felt that the pandemic had a negative effect on their breast training. There was an overall reduction in exposure to the key breast imaging methods when rotations took place during the pandemic. Completing a core breast rotation during the pandemic was less likely to attract trainees to higher breast training. Three out of four breast radiology consultants in their first year after receiving their Certificate of Completion of Training (CCT) felt the pandemic reduced their preparedness for becoming consultants. Positive outcomes included the increased use of online educational resources and remote multidisciplinary meetings.
As well as having a negative impact on breast radiology training overall, the pandemic has had a detrimental effect on attracting trainees to breast radiology as a future career. It is of key importance that trainees have a positive core breast rotation as this experience appears central to many trainees' decisions to pursue higher breast training. Increased use of online learning resources has also been positively received and is a valuable approach to learning that can be maintained in the longer term.

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