Category: Latest Posts

  • Talking Your Way Out of Burnout

    Talking Your Way Out of Burnout

    Before the COVID-19 pandemic, physician burnout was its own epidemic with radiologists consistently ranking among the most burned-out medical specialties. The acute and now chronic stressors of the COVID-19 pandemic further exacerbated radiologists’ wellness with 54% of radiologists reporting symptoms of burnout, according to the 2023 Medscape report. In addition to radiologists’ wellness, burnout has significant adverse implications on patient care and outcomes.

    In its most simplistic dissection, burnout is composed of three parts: depersonalization, physical and emotional exhaustion, and low sense of personal accomplishment. As such, the very fundamental aspect of our job as physicians, that of connecting and communicating with patients, may play a central role in physician wellness. A direct association can be observed between physicians’ level of satisfaction with their job and their ability to build rapport and connect with patients. Rapport and relationship building both decrease depersonalization and increase a sense of personal accomplishment. Although anxiety related to challenging physician interactions, which have been shown to last for days beyond the interaction, can lead to fatigue, if cumulative, these interactions may lead to exhaustion. Furthermore, anxiety surrounding challenging patient interactions, like delivering bad news, is more likely to occur if one is faced with such interactions infrequently, and thus feel unprepared or unskilled to navigate them. Demonstrating the critical impact of patient-physician communication interaction on physician mental health, a recent national study of breast radiologists’ wellness found that less time spent connecting with, educating, and consulting patients was statistically significantly associated with greater odds of reporting psychological distress and anxiety. Interestingly, although increase in frequency of more negative and charged patient interactions were reported by some radiologists in the study, no association between negative interactions and mental health was found. It thus appears that it is the length of time allotted for physicians to build rapport and make meaningful connections with their patients to educate and inform, rather than the nature of the interactions themselves, which significantly affects radiologists’ wellness.   

    https://www.radfyi.org/2023/02/15/words-of-wellness-katia-dodelzon/

    As institutions, practices, and individual physicians devise strategies for burnout mitigation, time and adequate focus should be allotted to patient-centered communication.  Operational leadership should be intentional in incorporating sufficient time for radiologists to discuss results and consult with patients into the daily workflow, not limiting interactions in favor of increased volume. Communication skill training should be increasingly integrated into radiology training curricula. In addition, training and effective communication skill resources should be emphasized and made readily available for all faculty to equip radiologists with the confidence to approach a variety of challenging patient interactions, thus diminishing communication-related anxiety. Radiologists themselves should emerge from behind the workstation, seeking out opportunities to consult and educate patients—as our very own wellbeing depends on it.

    <strong>Katerina Dodelzon</strong>, MD, FSBI
    Katerina Dodelzon, MD, FSBI

    Department of Radiology
    Weill Cornell Medicine

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  • Words of Wellness: Darcy J. Wolfman

    Words of Wellness: Darcy J. Wolfman

    Wellness at work starts with processes that improve your life, not impede it. Making your job something you look forward to, not dread. The first step is identifying what at work is leading to stress and unhappiness.  

    These can be big things, such as we need more staff to cover calls, or small items, such as moving the cutoff time to read cases from 5:00 to 4:30 pm. The hard part is that these changes are extremely practice-specific. What has helped in my practice is likely to be irrelevant to someone else’s. Therefore, it is critical that leadership listen to radiologists and be willing to make changes. There is no one-size-fits-all, and no one outside your practice can tell you what to do. So, it all starts with identifying pain points, and then getting leadership to listen and be willing to change. 

    <strong>Darcy J. Wolman</strong>, MD
    Darcy J. Wolman, MD

    Johns Hopkins Medicine

    In “Words of Wellness” on www.radfyi.org/, members of the ARRS Wellness Subcommittee share what “wellness” and “wellbeing” mean in their own clinical practices, research focuses, and everyday lives.

    Dr. Wolfman’s ARRS “Sound of Wellness” Playlist Selection:

    Take Me Out to the Ballgame!

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  • Words of Wellness: Jay Parikh

    Words of Wellness: Jay Parikh

    I am a breast radiologist and professor of radiology in the division of diagnostic imaging at UT MD Anderson Cancer Center. Most physicians go into medicine and endure medical school and radiology residency for the betterment of patients. Along the course of training and further into our careers, data shows a high prevalence of burnout in radiology. Additionally, physician burnout has been associated with negative outcomes for organizations, physicians, and patients. 

    Since burnout is a workplace-related phenomenon, radiology practice leaders need to stop redesigning the radiologist. Instead, they should focus on redesigning processes. Physician leadership is inversely related to burnout. Therefore, practice leaders need to be held accountable for radiologist burnout in their workplaces. Radiologists work very hard to become credentialed and take care of patients, so they should not be marginalized into feeling like cogs in a wheel. The road to overcoming the complex issue of radiologist burnout to wellness requires leaders to listen to their radiologists, co-create solutions, and build trust across their teams.

    <strong>Jay Parikh</strong>, MD
    Jay Parikh, MD

    Professor, Department of Breast Imaging,
    Division of Diagnostic Imaging,
    The University of Texas MD Anderson Cancer Center

    In “Words of Wellness” on www.radfyi.org/, members of the ARRS Wellness Subcommittee share what “wellness” and “wellbeing” mean in their own clinical practices, research focuses, and everyday lives.

    Dr. Parikh’s ARRS “Sound of Wellness” Playlist Selection:

    “Lean on Me” by Bill Withers

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  • How to Add Oil

    How to Add Oil

    In Mandarin Chinese, a phrase that is often said to encourage and support loved ones is 加油 (pronounced jiāyóu). In English, it directly translates to “add oil” or “add fuel.”

    My parents immigrated to the United States from Taiwan in the 1970s and 1980s. My siblings and I were born in Monterey Park, CA, a well-known suburban haven for East Asia Americans. My parents, however, quickly moved us to a predominantly White neighborhood in Orange County, hoping that we would assimilate for a better life. 

    After studying bioengineering in college, I pursued my PhD working on agricultural diagnostics. Early in graduate school, my dad was diagnosed with prior hepatitis B infection and liver cirrhosis. This is when I learned that Asian American men are 60% more likely to die of hepatobiliary cancer, compared to non-Hispanic White men. At the time, I felt ashamed that as a college graduate pursuing an advanced degree, I had been completely ignorant of this health disparity that was pervasive in my own Asian American community. Why did we learn so much about HIV and hepatitis C in school, and so little about hepatitis B? After extended discussions with career mentors and family, I ultimately decided to career-change into medicine; I would apply for and plan to attend medical school after completing my PhD. 

    As a non-traditional applicant, I was fortunate to be accepted into the Medical Innovators Development Program at Vanderbilt University School of Medicine—my dream program, where I could simultaneously learn medicine and keep alive my interest in engineering. As a West Coast native, however, I was not prepared for the culture shock that was waiting for me in the South. Upon transplantation, I was quickly surrounded by microaggressions, which were both confusing and yet oddly familiar. “But where are you really from?” was a common question for me, after offering that I am from Southern California, the place where I was born and spent my childhood.

    Comments about my surprisingly proficient English and catcalls on the street, using deranged pronunciations of East Asian languages from Japanese to Korean, made it clear that strictly based on my appearance, I was not perceived as “American” to my local community. This experience triggered repressed memories of bullying from grade school, when my peers would compare the shape of my eyes to floss and ask me to translate “ching chong ching chong” for them. To which I would respond, confused, that those were not Chinese words, and the words meant nothing. 

    During medical school, this sparked a new reflection and interest in my experience as an Asian American growing up and living in America. Through the Asian Pacific American Medical Student Association, I participated in an anti-racism workshop in which I learned about the racial triangulation theory (Fig. 1), published by Claire Jean Kim in 1999.

    Fig. 1—’Racial Triangulation’ adapted from Kim, Politics & Society, 1999.

    Kim explains the context of anti-Asian racism, which is based on anti-Blackness. Asian stereotypes such as “oriental” (read: exotic, foreign, anti-Western) and “model minority” (read: quiet, submissive, good-at-math), have been used to drive a wedge between the Asian and Black populations; driving home the message that if Asians would follow the anti-Black social racial hierarchy, they would be passively tolerated—albeit never accepted—in American society. Racial triangulation has since been further extrapolated to additionally include the Hispanic/Latinx experience. From this foundation, I understood that the best way to combat racism is for all populations of color to stand together, with respect and support for one another. 

    Today, I reside again in California. As a diagnostic/interventional radiology trainee, I have started a medical research initiative called Research with Inclusion, Social justice, and Equity or RISE. Our mission is to increase the representation of populations of color in medical research cohorts by supporting data transparency and empowering clinicians and clinical researchers to report the racial/ethnic breakdown of their study cohorts in their demographics table. A question I am often asked is, “how do you find the motivation and energy for it all?” Amid the rampant burnout that plagues our training culture, how do I “add oil” to keep going? My answer is that I reflect on my story, and I remind myself that my story is not unique. I get out of bed in the morning to work toward a hope that one day my story will become a fragment of a past culture in American medicine. And while it’s not a perfect method of fighting burnout, it’s certainly gotten me this far.

    What is your story? How do you add oil?

    <strong>Jessica T. Wen</strong>, MD, PhD
    Jessica T. Wen, MD, PhD

    PGY-3 IR/DR Resident
    Stanford University

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  • Can You Learn to Teach?

    Can You Learn to Teach?

    Who is the best lecturer you have ever watched in radiology? Who else comes to mind when you think of amazing educators throughout your radiology career?

    When you think of those individuals, and then think about the teaching you do, do you sort of think to yourself, “gosh, I am not that good, and I could never be that good?”

    Well, I have some good news for you: those amazing lecturers did not start off that way. None of them. I promise. Great teachers, in radiology and other fields, may have some innate talent, but all great lecturers learned through mentors, feedback, and/or trial and error how to get better, to the point of being great. There are too many aspects to becoming an amazing teacher for it all to happen by chance. Some of the great pioneers in radiology education may not have had formal instruction in pedagogy, but at a minimum, they all were probably attuned to incorporating direct and indirect feedback. And they probably had a strong internal process of improving.

    So, how can you get better at teaching, if you really want to be great?

    First, Seek Formal Resources

    Thankfully, there are many well-written resources available throughout the radiology literature. For example, see Heller and Silva’s excellent primer in the Journal of the American College of Radiology (JACR) for delivering a presentation that is informative, notable, and even inspiring .

    One of the best initiatives is ARRS’ own Clinician Educator Development Program (CEDP). Each year, up to 30 ARRS CEDP recipients are selected to receive a travel grant to attend a specialized on-site workshop during the ARRS Annual Meeting. With a curriculum promising increased proficiency in instructional skills, as well as educational activity design, the CEDP remains a highly interactive day of learning. Focusing on new and emerging pedagogical tools, while improving already acquired clinical acumen, over half of this expertly curated syllabus consists of hands-on learning. Offering a unique opportunity to interact with fellow enthusiastic clinician educators, attendees will engage further with the esteemed faculty ARRS has convened—previous CEDP instructors Travis Henry, MD (Duke) and Aaron Kamer, MD (Indiana), as well as Omer Awan, MD (Maryland), Judith Gadde, DO (Northwestern), and myself—on April 15 during the 2023 Annual Meeting in Honolulu, HI.

    Second, Ask for Feedback

    If your lectures are part of a series where evaluations are collected, then ask for them. If there is no feedback available, see if you can collect some. Try sending out your own survey perhaps? If all else fails, you can ask for feedback from one or multiple people you know who happen to be in the audience. One great option for garnering constructive feedback is asking a mentor who is talented at teaching to attend your lecture, then give you some notes. I know it seems like an imposition, but a good mentor will do this for you.

    Optimally, you are seeking honest answers to the following questions:

    • Did you lose your audience? If so, where?
    • What didactic points could have been explained better?
    • What aspects of your lecture were nearly perfect?
    • Are there insights you should keep to use for future talks?

    Third, Construct Internal Feedback

    Observe lectures from an esteemed imaging educator, asking yourself, “how does this lecture differ from mine?” Experiment with employing a similar style—without copying content, of course—and see if it could work for you. One key observation is that many lectures out there aren’t that great, yet it is incredibly easy to copy the predominant style that is used. Copying a mediocre style will make your lecture just as mediocre, so don’t do that. Look to see what the truly great lecturers in radiology are doing.

    To get your improvement process jumpstarted, right off the bat, allow me to share an immediate tip. For JACR, my colleagues and I examined what made a successful lecture, based upon thousands of comments regarding hundreds of lectures given to medical students.

    What was the characteristic most associated with well-received lectures?  

    …Interactivity

    Recently noted by AJR, too, the biggest pro tip is interacting with your audience, even if it seems hard or unconventional. You will want to do so in a warm and inviting way, free of condescension. Adding such an interactive element to your teaching will help you forge a stronger connection with all your learners.

    David Naeger, MD
    David Naeger, MD

    Director of Radiology, Denver Health
    Professor and Vice Chair of Radiology

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  • Words of Wellness: Jessica Wen

    Words of Wellness: Jessica Wen

    In “Words of Wellness” on www.radfyi.org/, read—and listen!—to members of the ARRS Wellness Subcommittee regarding what “wellness” and “wellbeing” mean in their own clinical practices, research focuses, and everyday lives.

    <strong>Jessica Wen</strong>, MD, PhD
    Jessica Wen, MD, PhD

    Stanford

    “Hello, everyone! My name is Jess Wen, and I am a current PGY-3 IR/DR resident at Stanford. My journey towards wellness has its roots in yoga. My yoga practice started in college, and during graduate school, I became a certified yoga instructor. During medical school, I taught yoga classes for my fellow medical students, weaving concepts of presence and self-awareness into my classes.”

    “As a trainee, I find that training and wellness are often difficult to reconcile; not just for myself, but also for my colleagues. The aspect of wellness that I struggle with the most is self-love. In medicine, we are trained with the expectation to place the hospital’s needs always before our own. Our training culture has classically praised the individual who finds more of themselves to give, without reprieve or compensation. The internalization of this culture manifests as a loss of self-worth. To balance this, I have found that the pillars of self-love can be derived from both the physical principles of yoga—flexibility and strength—in addition to the yogic principle of community.”

    “Flexibility, strength, and community are the mental and social foundations on which I build my self-love and self-acceptance. How do you foster self-love?” 

    Dr. Wen’s ARRS “Sound of Wellness” Playlist Selection:

    “Vitamins” by Qveen Herby

    The ARRS Professional and Practice Improvement Committee has been charged with overseeing our professional development programs, cultivating leadership opportunities, as well as initiating several practice quality improvements. Jay Parikh, MD (UT MD Anderson), chairs the new ARRS Wellness Subcommittee: a six-person working group with an overarching charter of promoting both workplace wellness and personal wellbeing to ARRS members of each practice type, private or academic, at every stage of their career, from residency to fellowship to active practice and beyond.  

    https://www.radfyi.org/2023/02/03/the-power-of-connection/embed/#?secret=RtcghZCxLC#?secret=swMTLY4s00
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    The opinions expressed on RadTeams are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.

  • Words of Wellness: Katia Dodelzon

    Words of Wellness: Katia Dodelzon

    In “Words of Wellness” on www.radfyi.org/, members of the ARRS Wellness Subcommittee share what “wellness” and “wellbeing” mean in their own clinical practices, research focuses, and everyday lives.

    <strong>Katerina "Katia" Dodelzon</strong>, MD, FSBI
    Katerina “Katia” Dodelzon, MD, FSBI

    Weill Cornell

    “I am a breast radiologist and an associate professor of clinical radiology at Weill Cornell Medicine. As an associate program director for diagnostic radiology residency for the last four years, and associate fellowship director for breast imaging, I have worked on various initiatives to augment our trainees’ work-life integration—a crucial factor in training the next generation of physicians.”

    “Building on this work in my recent role as vice chair of clinical operations for our department, I strive to further physician wellness, which has globally taken a hit in recent years. The implications are far-reaching, with direct effect on patient care and health care outcomes.”

    Dr. Dodelzon’s ARRS “Sound of Wellness” Playlist Selections:

    Either “Breathin” by Ariana Grande…

    . . . or “Paint It, Black” by the Rolling Stones—both just as effective

    The ARRS Professional and Practice Improvement Committee has been charged with overseeing our professional development programs, cultivating leadership opportunities, as well as initiating several practice quality improvements. Jay Parikh, MD (UT MD Anderson), chairs the new ARRS Wellness Subcommittee: a six-person working group with an overarching charter of promoting both workplace wellness and personal wellbeing to ARRS members of each practice type, private or academic, at every stage of their career, from residency to fellowship to active practice and beyond.  

    https://www.radfyi.org/2023/02/03/the-power-of-connection/
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    The opinions expressed on RadTeams are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.

  • The Power of Connection

    The Power of Connection

    Over the past two decades, the practice of radiology has changed, with radiologists having become more isolated. With the digital revolution precipitating widespread implementation of both electronic medical records and PAC systems, radiologists have increasingly worked from workstations with less patient contact and decreasing personal interactions with referring clinicians.

    The COVID-19 pandemic further isolated radiologists. The initial social distancing requirements, use of PPE, promotion of remote work environments, and reduced meaningful social interactions during this era have amplified the loneliness of radiologists.               

    As humans, radiologists have a fundamental need to socially connect. And for good reasons: social isolation and loneliness, markers of poor social health, have been associated with multiple adverse psychological outcomes, especially sleep fragmentation, as well as anxiety and depressive symptoms. Studies suggest loneliness is a risk factor for stroke, as well as for hypertension, cognitive decline, and progression of Alzheimer’s dementia. Restoring a sense of community, both at work and beyond, can help radiologists overcome isolation, improve their overall wellness, and mitigate significant health issues.  

    How does a radiologist do so? 

    Radiology is a team sport, in which radiologists interact daily with patients, non-clinical staff, technologists, and other radiologists. In the workplace, these interactions can be leveraged to create a sense of community. A positive attitude among teammates can help create a bond of positive energy. Social gatherings organized by the clinical team, both within and outside of the department, can help further create camaraderie between members of the team.

    Radiologists also have opportunities to develop connections with referring clinicians. Multidisciplinary tumor boards offer a unique opportunity for radiologists to interface directly or virtually with referring clinicians and become engaged in the care of complex patients. This collaborative atmosphere promotes personal job satisfaction.

    Organizations can be instrumental in supporting a culture of community at work. Physician lounges provide a safe space for radiologists to interface with physicians from other specialties. Organization-led social events, such as fundraisers and family outings, may further promote a sense of collegiality.

    Beyond the organization, another way for radiologists to connect with other radiologists is to attend regional and national society meetings. A great example is the ARRS Annual Meeting, to be held this year from April 16-20 in the beautiful backdrop of Hawaii. The meeting offers opportunities to not only learn educational content from leading experts, but also to network with other radiologists from around the globe. Opportunities to eat lunch, socialize, and collaborate on research projects with fellow radiologists await. Meanwhile, the inaugural ARRS Radiology Wellness Summit will be a wonderful cultural medium to cross-fertilize ideas, helping us all move forward in the wellness and wellbeing space. Hope to see you there!

    <strong>Jay Parikh</strong>, MD
    Jay Parikh, MD

    Professor, Department of Breast Imaging,
    Division of Diagnostic Imaging,
    The University of Texas MD Anderson Cancer Center

    In “Words of Wellness” on www.radfyi.org/, members of the ARRS Wellness Subcommittee share what “wellness” and “wellbeing” mean in their own clinical practices, research focuses, and everyday lives.

    Dr. Parikh’s ARRS “Sound of Wellness” Playlist Selection:

    “Lean on Me” by Bill Withers

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  • Bye Bye, Work-Life Balance—Welcome, Work-Life Integration!

    Bye Bye, Work-Life Balance—Welcome, Work-Life Integration!

    Are you voluntarily working longer hours and sacrificing your personal life for it? If the answer is yes, then you have no work-life balance. 

    The idea of work-life balance is to achieve a state where the demands of work and career and the demands of our personal lives are of equal priority. Work-life balance acknowledges that our careers influence our personal lives and vice versa — one cannot thrive without the other. Ultimately, by keeping work and life in balance we hope to be less fatigued, more focused, and more productive in all aspects of our lives.  

    The shift to a culture of work-life balance has had a number of positive effects: 

    • Health is now recognized as essential for work-life balance. Many employers offer health initiatives, such a fitness or weight loss programs and healthier food choices for employees. 
    • Employees feel empowered to say “no” to projects they feel overwhelms their bandwidth. 
    • Employers conduct engagement surveys to keep tabs on factors that can raise employees’ levels of dissatisfaction.
    • Employees are becoming more mindful of needing to take regular breaks. 
    • Many employers now offer flexible work schedules, which may include flexible hours and/or remote working options.
    • Employees seek coaching to cope with managers, coworkers, and rising workloads.
    • There is an expectation that technology “gets the job done,” meaning that technology addresses daily work challenges and is effective in helping users to achieve goals and objectives, resolve and avoid problems, and make progress in their lives. 

    Work-life balance means that work-related meetings are not scheduled outside of regular office hours, not during break times, and not in the afternoon on the last day of any work week. People nowadays also frown upon receiving work emails on weekends. 

    The strict separation of work and life, however, can be difficult. Trying to maintain artificial barriers between work and the rest of our lives can cause tension and feelings of guilt when work does intrude on our personal lives and vice versa. Work-life integration refers to the idea of “blending” work and personal responsibilities, eliminating any tensions or feelings of guilt. 

    The idea of work-life integration assumes that a person’s professional and personal goals can be aligned so that one is not taking away as much from the other. Work-life integration will particularly become important as more Millennials and Gen Zers control the workforce. 

    Post-Covid technological advances in our workflows, enabling remote work at a much larger scale than before, is an initial step towards work-life integration, breaking down barriers between work and personal time. It is acceptable again to let work tasks bleed into free time or even during vacation, while attending to personal matters, such as family obligations or health issues, is allowed to bleed into work time. One can leave work for a few hours to pick up a sick child from school and catch up on work from home later in the day. 

    Radiology more than other medical specialties could pioneer work-life integration. There are already existing work models where radiologists are assigned a certain volume of studies that they have to read during a shift, and there can be some flexibility as to when they need to issue final reports. Many radiologists already work entirely or partially from home.

    In the current job seekers’ market, everyone will choose the work conditions that are best for them. If you find yourself having trouble hiring folks, it may be worthwhile pondering work-life balance or integration and how it could work for your hiring goals.

    Nadja Kadom, MD
    Nadja Kadom, MD

    Director for Quality, Department of Radiology, Children’s Healthcare of Atlanta
    Interim Director for Quality, Department of Radiology and Imaging Sciences, Emory Healthcare
    Professor, Emory University School of Medicine

  • Anything Goes—Is It True for Leadership Styles?

    Anything Goes—Is It True for Leadership Styles?

    There is no doubt that, over the next few years, we will need more leaders in radiology that can fill the shoes of the mighty baby boomer generation. Many early career radiologists believe they do not have what it takes for leadership. But is that true? Is it a matter of “nature versus nurture?”

    I have concluded that “(almost) anything goes” when it comes to leadership styles, and that while it helps to be genetically endowed with such skills, everything can be learned. Or is that even necessary? After all, most everything, from developing a vision and mission to executing our daily work, can be driven by teams, and it can be the total of team members that has the skill set, rather than a single leader who has it all. After all, this is reflected in many academic radiology departments, where the leadership cadre is made up of vice chairs, who bring very specific leadership and subject matter skills to the table.

    When I first became curious about a leadership journey in my career, I asked my then section chief and department chair for leadership book recommendations. One recommended Edward Kennedy “Duke” Ellington’s biography. In reading the Duke’s biography through a leadership lens, it became clear to me that he valued the musicians in his orchestra very much. In fact, he wrote music that would showcase the skills of individual musicians. In addition, Ellington was a phenomenal businessman who was committed to delivering music of the highest quality.

    The other recommendation was to read Endurance, a book about the explorer Sir Ernest Henry Shackleton and his expedition to Antarctica on the ship Endurance. The book details how the ship got trapped in packed ice and sank, and how Shackleton’s exceptional leadership resulted in the survival and rescue of all crew. In essence, Shackleton never wavered in his vision of survival for the entire crew, which informed all decisions he made along the way. On the other hand, in terms of planning this expedition for all eventualities, Shackleton miserably failed in his leadership.

    In my career, I have both employed and lived through a large variety of leadership styles, and I have concluded that more often than not, circumstances inform which leadership style works best.

    Authoritarian – Participative – Delegative

    While there are undoubtedly negative connotations to being an authoritarian leader in the political world, this leadership style can be very effective when projects need to be completed quickly. A group may prefer this leadership style, when the leader is the most knowledgeable group member. This style does not, however, support the professional skills and advancement of others.

    Participative or democratic leadership, on the other hand, is all about welcoming diverse opinions and collaboration. Research finds that this leadership style leads to higher-quality outcomes, but it can take longer to get buy-in from all team members.

    Delegative leadership is a laissez-faire style. The leader is removed from the team’s process, but expects a certain outcome. This could be successful when all group members are qualified experts.

    Visionary – Coaching – Affiliative – Commanding – Pacesetting

    Visionary leadership is often authoritative and can inspire and motivate others. However, a vision only takes the team so far. Having a clear vision to hold on to can help teams that are undergoing dramatic changes within the organization, such as a new practice leader.

    Coaching leaders are those who can help team members improve to support the organization’s goals. This requires the ability to give feedback, which can be an artform in itself…

    The affiliative leader is relationship-focused and creates harmony among team members. However, if harmony is of the utmost priority, team performance could suffer from lack of constructive feedback.

    The commanding leader coerces the team through policies and procedures. As a sole leadership style, this can lead to disengagement of team members. Undoubtedly, though, policies and governance are the necessary foundation for creating accountability and guiding performance assessments.

    Pacesetting leaders serve as an example in productivity, performance, and quality. Leaders who create clear requirements for their teams and set deadlines may be very successful, but this style can also result in overworked teams.

    Transformational – Transactional

    The transformational leader uses coaching and other means to empower teams towards building skills and growing towards a common goal. Meanwhile, the transactional leader drives performance through rewards and punishment. Since external reward/punishment systems work better for achieving short-term goals, this leadership style may not be successful in the long run. I hope this brief overview piques the interest of radiologists who are interested in leadership, but who are unsure if they are cut out for it. A good starting point may be to ponder one’s strengths and find a leadership opportunity in a setting that would benefit from existing skill sets.  

    Nadja Kadom, MD
    Nadja Kadom, MD

    @Nkpiano

    Director for Quality, Department of Radiology, Children’s Healthcare of Atlanta
    Interim Director for Quality, Department of Radiology and Imaging Sciences, Emory Healthcare

    Professor, Emory University School of Medicine

  • A Recipe for Resilience: 10 Key Ingredients to Add to Your Mix

    A Recipe for Resilience: 10 Key Ingredients to Add to Your Mix

    This post was originally featured in ARRS InPractice.

    “This pandemic is really getting me down… I’m not sleeping well… Small things worry me constantly… My concentration drifts while interpreting studies… Antacids are taking care of my epigastric symptoms… Alcohol has become a necessary crutch to help me sleep… Everybody seems so needy around me… The media is driving me insane… The sense of loss overwhelms me at times… I cannot bear the thought of more Zoom meetings…”

    Resilience. It’s a concept that predates the pandemic and one that we’ve heard about in personal development books, TED Talks, and leadership courses many times before. The word conjures a sense of unshakeable inner strength that’s impermeable to outside forces, like a giant African baobab tree—also known as the continent’s “tree of life”—during a torrential storm. You might define resilience as the capacity to recover and bounce back from adverse circumstances, such as those many of us are currently experiencing, as illustrated by the sampling of comments above.

    It often feels like the pandemic swiftly derailed the pre-2020 tools and strategies we had introduced to our organizations to identify and combat employee burnout and support the collective health and wellness of our teams. While stressors have expanded and amplified, the concepts that were leading us on a path to healthier workplaces are still valid and valuable, particularly when it comes to resilience. With intention, practice, patience, and persistence, resilience can be learned, sustained, and strengthened; with resilience, we can emerge from our proverbial emotional basements, even during the most turbulent of weather.

    Opening the Cookbook

    While it’s not quite as simple as following a step-by-step recipe for your favorite meal, several key ingredients can help you develop resilience. Let’s explore 10 of them here.

    1. Take care of yourself, first and foremost: If you’re a leader, remind yourself of the airline analogy to put on your own oxygen mask first. Learn to practice mindfulness to slow down and reduce anxiety. Learn to focus on being intensely aware of your senses and feelings in the moment, without interpretation or judgment. Be mindful, too, that you may be using unhelpful coping solutions. Try to eat healthily, sleep to rejuvenate, and exercise as best as you can, wisely. Doing so should boost your capacity for physical resilience. Consider strategies to boost your mental resilience, as well. How do you reignite your energy and creativity after challenging situations? Are you able to effectively disconnect? Build time into your schedule to recharge. Develop coping skills to help you manage stress, so that it doesn’t compound. One example of a valuable coping mechanism is laughter, which can reduce anxiety and increase our intake of fresh oxygen. Try to find ways to laugh each day, as part of your self-care practice. You can even find laughter yoga exercises on YouTube.
    2. When something is not quite right, recognize, acknowledge, and call it what it is: Stress. Anxiety. Overwhelm. Depression. PTSD. Whether it is a formal diagnosis from a care provider or a gut instinct that you have, it’s OK not to be OK. The pandemic is amplifying our national mental health crisis. Recognize and mourn your losses, no matter how big or small you think they are. Communicate openly and honestly about your current state of mind; don’t minimize or ignore your symptoms until they become intolerable. Share your concerns with your primary care provider, a licensed therapist, a trusted family member or friend, or a 24/7 hotline. If you are in a potentially life-threatening situation, call 911, or go to your nearest emergency room. Opening up and asking for help can be terrifying, but you are worth it. No one is alone here. Seek the support and care that you deserve and need.
    3. Find your sense of purpose: Develop your personal W-H-Y? Find intentional ways to connect to your larger life purpose and learn to savor them. What are your volunteer efforts? What does your charitable giving list look like? Altruism drives a sense of purpose and is a recognized trait of resilient individuals. Try to integrate your work and life effectively for you. Strive to be a realistic optimist and, rather than focusing on the negative, hone in on what you can contribute to your community, region, state, or country.
    4. Get connected: Establish and nurture a supportive social network. Who comprises your safety net? Whose safety net are you in? Help others to support and nourish you by building a social resilience community. Never be afraid to lean on your support systems, even if virtually. How did you build your support group? Do you have an online community? Develop positive and trusting relationships in which you can work together to endure and recover from stressors. By listening and hearing, we can be kind and compassionate to others when they need it most. Do a proverbial mitzvah!
    5. Find your resilience role models: On a personal level, I derive such joy and inspiration experiencing the resilience of my immediate family members. As a South African, it will also never cease to amaze me when I consider the remarkable resilience shown by Nelson Mandela. His endurance and persistence in the face of severe adversity were coupled with his ability to show emotional regulation, empathize, build connections, demonstrate self-efficacy, and stick to his guiding moral compass through authenticity. His favorite poem was “Invictus,” written by William Henley, which ends with the powerful line, “I am the master of my fate / I am the captain of my soul.”  
    6. Seek to constantly learn and improve: Be coachable and seek feedback that you learn from and act upon. Seek this feedback from those sources most likely to be helpful to you. Recognize that change can be good, however inconvenient or uncomfortable. View so-called “failures” as learning and improvement opportunities and embrace them; activate your action plan, rather than dwelling on what might have been.
    7. Know what emotional intelligence looks like: Practice self-awareness by knowing your stress levels and noticing your emotions. Train your brain—build emotional intelligence, moral integrity, and physical endurance. To boost your emotional resilience, work on understanding, appreciating, and regulating your emotions, while consciously choosing your feelings and responses to avoid being reactive. Learn to become self-aware. This includes recognizing what drives your stressors. What pushes your buttons? Finding and sticking to your moral center may aid this journey.   
    8. Find ways to relax and decompress that work for you: Some examples include spending time with friends, pursuing hobbies, cooking, meditating, and listening to music. Each of these can be enjoyed in groups or individually, depending on what you prefer. As one example, photography is an art that can be practiced in mindful ways, shared with colleagues, and even used as a communication and connection tool. It might even influence your choice of travel locations and online connections. Surround yourself with positive energy. Misery doesn’t love company—find new ways to manage or even avoid adversities and adversaries. Have an executable plan to eliminate your blockages.
    9. Practice gratitude and self-compassion: Hardwire this into your daily activities list; it will help you to feel content. This might simply include journaling things that you are grateful for. You already possess a series of resiliency tools and have likely overcome adverse situations that you learned from. Your journey has already begun, and you have endured 100% of your worst days. Congratulate yourself for this.
    10. Reflect: This can go hand-in-hand with journaling. Simply put, sit quietly with the events and feelings of the day and see what comes up. Committing to creating the time for reflection allows one to build and increase self-awareness (an important component of emotional intelligence), encourages learning, and opens doors to being more adaptable. For events that occur, consider what happened, how it made you feel, and what lessons or new approaches you learned from the experience.

    Sharing the Recipe

    As a leader, your resilience impacts your performance, as well as the performance and engagement of your teams. Stressed leaders engage in fewer positive leadership behaviors, such as enunciating optimistic visions, setting and overseeing goals, communicating confidence, clarifying roles, showing genuine appreciation, and recognizing performance. Stressed leaders can become passive—they step in only when needed, tend to avoid decision-making, and can be emotionally absent. These attributes get noticed and impact teams. Resilient leaders can keep calm under pressure and develop additional skills (a component of posttraumatic growth) in the face of adversity. Through self-reflection and feedback, resilient leaders have a keen sense of the main components of emotional intelligence.

    Resilient leaders can also regularly assess their leadership effectiveness and styles, more readily responding to change and unexpected situations. Striving to learn and grow continuously, resilient leaders are often purpose-driven individuals—they can visualize their work effort as being meaningful. Resilient leaders cultivate relevant and helpful relationships in their internal and external work environments that support them through tough times.

    Why Is Resilience at Work Important?

    Resilience shapes the way employees respond to the stress of change. It also relates to work engagement, job satisfaction, and organizational commitment. Resilience is inversely related to the frequency and manifestations of burnout and can improve organizational and employee performance.

    How Do We Recognize Resilient Behaviors in Others?

    A spectrum of characteristic behaviors and skills is recognized under the resilience rubric. Many of these are also included under a larger umbrella of effective leadership behaviors. A person who manifests resilient behavior communicates clearly, thoughtfully, and consistently. Moreover, effective leaders may design a strategy for communicating and managing change that accounts for different stakeholders and their communication preferences. Resilient individuals are coachable, regardless of their position in a hierarchy, and many seek opportunities for learning and improvement. They are willing to embrace change, and, ideally, they’re skilled at managing it. Resilient individuals are comfortable saying, “I don’t know” (and “I would like to learn”). They know how and when to take bold risks or when to initiate new ideas. Similar to effective leaders, resilient individuals are willing to and do invest in the development and advancement of others.

    Those with high levels of resilience are better equipped to cope with stressful situations. They tend to see change as an opportunity, are optimistic, adaptable, and realistic about realities, and engage colleagues for support. Resilient individuals possess emotional regulation skills and don’t allow stress to impede their functioning. They practice self-compassion to reduce harsh self-criticism, soothe difficult emotions, and find sources of motivation. Resilient individuals show cognitive agility, a difficult skill to develop, which entails shifting how one thinks about negative situations.

    Let’s face it: It’s really difficult learning to become resilient. It takes time, persistence, effort, commitment, energy, and a drive to succeed. We do know that resilient teams are best served by resilient leaders. Now more than ever before, we need our imaging teams to function effectively. Our teams should be equipped with resilience to face ever-changing challenges and unanticipated adversities, and whether they are or not begins with us as leaders.

    About the Author
  • Reimagining and Reinventing Postpandemic Radiology

    Reimagining and Reinventing Postpandemic Radiology

    This post was originally featured in ARRS InPractice.

    Some days, it’s hard to recall what prepandemic life was like. Things have forever changed in light of this historic global event, and it’s vital to reflect and process these last three years. We’ve endured some of the most trying times of our careers, but we also have a bright future as a medical community ahead. You’re wondering what that might look like and how we can collectively “skate to where the puck is going to be, not to where it has been,” as Wayne Gretzky famously said.

    COVID-19 precipitated a fundamental change in clinical service delivery, teaching, research, staff retention, employee wellness initiatives, and communications strategies. We amended workplace safety standards and practices, stood up and resourced remote teams, recruited trainees virtually, and transformed in-person grand rounds programs into digital ones. These are just some of the many efforts that we as a specialty undertook to protect our people, uphold our missions, and keep our teams employed. And while not all changes were novel ones, the pandemic catalyzed their implementation. We now have tremendous momentum to continue innovating, especially as we begin to emerge from crisis mode together.

    Accelerating Change

    Here at Beth Israel Deaconess Medical Center, we simply couldn’t have managed this public health crisis without our highly effective, efficient, and resourceful operational surveillance systems and teams. Some of these teams were in place before the pandemic started; they rapidly responded to the initial phases of COVID-19, then swiftly transitioned into a multidisciplinary incident command structure to assess, rethink, reinvent, iterate, and communicate our health care systems and strategies on a daily, hourly, and minute-by-minute basis. This collaborative structure operated in real time and kept our trains running, on schedule and on the tracks, far more often than not. Light started to appear at the end of the tunnel, and then, the alphabet of variants arrived. It soon became clear that we would never return to prepandemic normalcy. A fundamental shift had taken place in the way we delivered our services, and some of this change represented the necessary digital transformation many had envisioned long before COVID-19 struck.

    So, what are our next steps? How can we effectively shift from a reactionary mode to one that is deliberate and purposeful? What structure will best support the necessary regrowth phase that will support our medical practices and organizations? Now is our time to be accelerators rather than incubators, to reinvent and rebrand our skills and clinical contributions, and to be thoughtful and strategic in the process. This is where the most strategic, imaginative, and operationally agile teams will lead the way and define our recovery. Those who embrace change and progress will be the best positioned to thrive. Lead the change. Be the change.

    Building COVID Recovery Hubs

    Let’s be the disruptive thinkers our field will be proud of. Define, then communicate your future radiology vision. Do this in an inclusive manner that involves all role groups. For such plans to be adopted and successful, leaders will need to continue to create forums for staff to weigh in, ask the right questions of their teams, listen to feedback, barriers, needs, and ideas, and provide other ways to share input, such as through short pulse surveys in a departmental newsletter or real-time polls during meetings. Ensure everyone’s voice is heard and incorporate major common themes into your plans.

    We suggest constructing and resourcing a formal COVID recovery hub, which can house your postpandemic mission, vision, and recovery playbook. Appoint and support a multidisciplinary team to lead and own these pioneering transformation efforts. Who have you appointed to lead your radiology recovery, reinvention, and reengineering transformation? What does your “r4” portfolio look like? By answering these questions, you will help your practice continue to keep its staff and patients safe, deliver exceptional care, manage ongoing people and supply chain shortages, support staff morale and wellness, nurture remote teams, and effectively communicate and engage with a multigenerational workforce.

    Reimagining Administrative Functions

    As part of your COVID recovery hub, consider the roles, responsibilities, and constituents of your leadership team. Are you best positioned for your recovery? Now might be a great time to reimagine these elements and challenge the traditional hierarchy, as we work to flatten authority gradients, build diverse, inclusive, and multigenerational teams, and ensure that form follows function. Additionally, these roles have likely transformed out of necessity during the pandemic and might need to evolve to meet your practice’s future needs.  

    Let’s be a little provocative: how can we identify the best person to be our “knowing exactly where the puck will be in 2030” portfolio leader? Actually, this is not a task for one person—and this is precisely why building and sustaining high-performing diverse and inclusive teams will become paramount and essential. Proudly establish your recovery hub, appoint a vice chair of recovery and reinvention to lead this effort, then establish and resource new portfolios to signal just how serious you are about recovery, regrowth, and reinvention. For example, have you considered the future of your remote teams? Based on national employee preferences, it’s clear that some level of remote work is here to stay. Perhaps, as part of a practice’s new digital innovation and transformation lab, it could create a remote workplace and team-building portfolio. Will your organization continue producing short video messages, digital newsletters, social media content, and academic webinars? What will your postpandemic communications strategy look like? Perhaps it’s a question for a newly formed digital communications and connections team. While these structures might not be novel in a large, digital-first corporate setting,they would be a progressive leap forward for many of our major academic medical practices.

    Additionally, we all know that health care delivery has progressed to incorporate population health, cost reduction improvement efforts, care coordination and integration, and customer experience, among other important factors. Simply put, our aim is to deliver the highest-quality, safest possible care and experience at the most sustainable costs. This boils down to value, and who better to drive it than an effective chief value officer?We’ve certainly been talking about this value proposition for quite some time already. On a different but equally important note, we must think about how we will continue to support the health and wellness of our staff postpandemic, especially during our nation’s mental health crisis. Is there an influential and compassionate leader on your team who could become your chief wellness leader and drive these vital efforts to aid your entire team?

    The structure of a leadership team should primarily relate to its intended function and purpose. Once you have reconfirmed your foundational core purpose, reimagined your vision and mission, and defined your annual goals, then form the team (and define their precise roles) that will help you reach your ideal future state. Energize your teams by including them in strategic brainstorming and planning sessions, imagining an exciting and successful future together.Designing a newoperational landscape is not a task for one person, which is why building and sustaining high-performing, diverse, and inclusive teams will be paramount.

    The interesting exercise that we are all engaged in now is to define that future state. Has anybody considered a leader of a recovery and reinvention portfolio? Your entire team wants to contribute! Be inclusive and build diverse teams.

    Mapping New Pathways

    This is an era of posttraumatic regrowth. Reimagining your pathway should be an inclusive, aspirational, and even inspirational process. Be thoughtful and strategic when redefining your path forward toward the new normal you and your team aspire to achieve. Reengage and revitalize your most precious resource, your workforce. Recommit to safe practices, wellness initiatives, and high-performing team building. Reconnect your teams, and work to sustain these connections. Reimagine and rethink your strategic plan and goals, and start your new journey today. Those who will flourish and thrive will do this effectively, thoughtfully, and strategically; consider the long-term goals, map out your route, and take action. As you shift from managing operations to imagining the future, try to shift your focus from keeping the trains running to considering where new rails could be built. Periodically, it’s important to pause and ponder—to consider not only how trains can be better engineered, but also to contemplate whether train travel will be a safe and efficient customer choice in the future. That’s strategic thinking.

    Let’s try to simplify. You’re done with reacting, reflecting, and responding. You’re starting to see some light at the end of this tunnel. You’re hoping that omicron is the last symbol of this pandemic alphabet. Now, more than ever before, is the time to look forward, plan your recovery strategy, and focus on building and sustaining innovation. The practices that are most likely to thrive are already thinking outside the traditional administrative oversight box. And they are moving ahead right now.

    And, finally, find ways to share your experiences of this journey. We’re all traveling new paths and learning as we go. We must learn from each other’s successes and missteps, and there will be plenty of both. As we build our departmental COVID recovery hubs, we also need to design and build collaborative teams to communicate and interact with institutional, regional, and national COVID recovery hubs, to the extent they exist. These new systems must be capable of redefining and reimagining the future, so that we can all travel along the path of progress together.

    It’s now time to be intentionally inclusive, as we commence this new journey.

    About the Authors
    Jonathan Kruskal

    Melvin E. Clouse Professor of Radiology, Harvard Medical School
    Chair, Department of Radiology, Beth Israel Deaconess Medical Center

    James V. Rawson

    Senior Lecturer on Radiology
    Beth Israel Deaconess Medical Center