The Power of PIER Support

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The Pipeline Initiative for the Enrichment of Radiology (PIER) program was founded with the goal of promoting radiology to medical students from different backgrounds. This comprehensive approach ensures that the program opens doors to a broader pool of talented students, fostering a more inclusive and representative radiology field. By focusing on communities that have historically not pursued careers in imaging, PIER helps create opportunities for students with various life experiences.

Now in its ninth year, PIER engages first-year medical students in radiology research while partnering with dedicated preceptors who mentor them through eight weeks of interactive lectures.

“There’s limited exposure to radiology early in medical school, so having an opportunity to learn these skills allowed me to explore my interests more than most medical students do,” says Amanda Pomeroy, MD, who completed PIER in 2021 as a first-year medical student at Tufts University School of Medicine.

By offering early exposure to radiology and ACR, the PIER internship equips students with imaging knowledge, research and presentation skills, and invaluable connections that prepare them for residency, helping “to propel them forward,” says Michele H. Johnson, MD, FACR, FASER, FASSR professor of radiology and biomedical imaging, neurosurgery, and surgery and director of interventional neuroradiology at Yale School of Medicine and Director of the ACR PIER Program.

Evolution to Virtual Learning

Modeled after a similar program, PIER launched in partnership with Nth Dimensions™, an educational nonprofit dedicated targeting medical students interested in orthopedic surgery. Initially, the PIER program selected five interns each year who worked alongside preceptors in academic and private practice settings.

After three years of partnership with Nth Dimensions, ACR spun PIER into an independent program, doubling its enrollment. Then, the COVID-19 pandemic struck, threatening the survival of the in-person internship.

Johnson, who has served as a preceptor since PIER’s inception, suggested converting to a virtual program. To substitute the on-site research experience, she proposed a partnership with ACR’s Case in Point (CiP) publication, giving students a chance to submit research under the guidance of their preceptors, then present it to their peers and at the National Medical Association (NMA) annual meeting.

Although students were no longer working side-by-side with practicing radiologists, the virtual move added several benefits. By holding lectures online rather than on-site, the number of participants ballooned. In 2021, PIER interviewed 23 students and accepted 14. In 2022, they interviewed 64 and accepted 27. In 2023, the program hit a record of 91 applicants for 43 spots.

Meanwhile, the virtual setting allowed a broader panel of radiologists to participate, both as presenters and preceptors. “When you’re in-person, you’re limited to faculty who can participate on-site,” Johnson says. “Now, we can bring in subspecialists from across the country, so students can see different points of view.”

Even in a virtual setting, Johnson has been impressed by the cohesive bonds formed through the program. “The PIER program created a little radiology family,” says Kayla Davis, MD, an interventional radiology resident at the University of Maryland who participated in PIER in 2020 as a student at Howard University College of Medicine. “I didn’t know any students at my medical school who were pursuing radiology, so this community has been invaluable.”

The Value of Mentorship

Since PIER moved online, preceptors have explored new ways of engaging students to foster valuable mentorship bonds — such as by having students fill out HIPAA forms so that they can sign in for readouts, inviting students to attend resident bootcamps or helping them apply for research and travel grants to attend medical conferences. At a minimum, preceptors carve out time to meet remotely with students to develop a CiP presentation while answering questions about career opportunities.

“These relationships are critically important to the students because it shows them role models,” says Johnson, who continues to mentor students in addition to assigning other preceptors.

Students are matched with practicing radiologists who share a common background, when possible. For example, Esai Hernandez, MD, a diagnostic radiology resident at the University of New Mexico, who completed PIER in 2020 as a student at Eastern Virginia Medical School, was matched with Jenny T. Bencardino, MD, then chief of musculoskeletal radiology at Penn Medicine and professor of radiology at the Hospital of the University of Pennsylvania. “I never had any mentors that shared my background in medical school, so working with Dr. Bencardino was inspiring,” Hernandez says. “Connecting with her changed my life by giving me opportunities and great advice.”

On the career side, Pomeroy’s mentor, a neuroradiologist at the University of Pittsburgh Medical Center, helped her explore her interests and, later, submit applications for a radiation oncology residency, which she’ll begin at the University of Virginia later this summer.

“While lectures are a great way to get a lot of information to a group of people, sometimes in that setting, it’s hard to ask personal questions that are unique to your situation,” Pomeroy says. “The benefit of the PIER program is that you can take what you’ve learned in a lecture and then speak individually with a radiologist and ask more in-depth questions tailored to your specific interests.”

Plus, Johnson points out, mentorship is a valuable experience for the preceptors as well. “This is really rejuvenating for the mentoring radiologists,” she says, encouraging senior and retired radiologists to get involved. “Just when you’re feeling burned-out, like no one cares about what you’re doing, all of a sudden you’ve got someone enthusiastically asking questions and showing interest.”

Research Experience

Aside from ongoing mentorship, the preceptor’s main role is to help students develop a research project for presentation and publication in ACR’s CiP database. This introduction to the publication process is essential for students embarking on medical careers.

“As radiologists, we have to be able to explain findings, so the ability to orally present a story is really important,” Johnson says. “To create that story, they’ve got to do the research, understand the imaging, create a discussion and presentation around it and meet a deadline.”

Whether digging into a rare disease like neurosarcoidosis, in Pomeroy’s case, or more common diagnoses like tenosynovitis, which Hernandez researched, these projects force students to get familiar with imaging interpretation. “Doing this research was a good way to immerse myself in the world of radiology,” Hernandez says. “I felt more confident looking at X-rays and being able to understand radiology terminology so that I could build on those foundations in my later rotations.”

PIER students have gone on to present their research at other radiology meetings beyond the NMA. For example, six students presented posters at the American Society of Pediatric Neuroradiology annual meeting over the last two years. Others have participated in AMA events or received research grants from organizations like the Radiological Society of North America. Several have earned travel grants to the ACR.

Positioned for the Future

Although the curriculum only spans eight weeks, PIER support doesn’t end when students complete the internship. The program also offers a residency application bootcamp in August and another session early in the year to guide alumni through their rank lists and residency plans.

“Radiology’s becoming very competitive,” Hernandez says. “This is a good opportunity for medical students to start tailoring their research and experiences to stack their applications so that they look good for the match, which is a difficult process.”

While it’s hard to enumerate the total number of students who have ended up in radiology, two students from the inaugural class will complete diagnostic radiology residencies and go on to fellowships in 2025. Johnson notes that more than half of the 2021 PIER class are applying for radiology residencies for Match in 2025. “We don’t expect 100%,” she says. “We’re either creating radiologists, or we’re creating friends of radiology.”

The success of the program lies not only in increasing the number of radiologists but also in paving the way for the many medical students who historically have not considered radiology when they choose their medical specialty. “It’s not just ethnic and gender differences,” Johnson adds. “It’s students who are the first in their family to graduate high school; it’s students who come from MD and DO schools that don’t have in house radiology programs.”

This focus of the program is what attracted students like Davis, Hernandez and Pomeroy to the program. “It’s important that people from different backgrounds get exposed to fields that they’re not traditionally exposed to in medical school,” Pomeroy says. “In any specialty, the wider range you have when it comes to people, their experiences and the education they bring to the table, the better doctor you’re going to be.”

If not for the early exposure gained through PIER, many alumni may have never discovered a career path in imaging — and for that, these future radiologists are grateful as they pass the torch to the next generation.

“As an African American and a female, when I was applying [for residency], I looked for people who looked like me, because it’s important for building connection and community,” Davis says. “Five or 10 years from now, medical students will see me as someone who understands what they’ve gone through. That’s why we should make sure that there are people from different backgrounds, cultures, countries and communities represented in radiology.”

By Brooke Bilyj, freelance writer, ACR Press