Graduated Autonomy in Breast Imaging Fellowships: A National Survey of Fellowship Program Directors

This study assessed opportunities for graduated autonomy in fellowship programs registered with the Society of Breast Imaging (SBI) Fellowship Match.

A 16-question survey developed by the SBI Fellowship Match Committee was distributed electronically to fellowship program directors registered with the SBI. Responses were analyzed, with subgroup comparison using Fisher's exact test.

The response rate was 51.5% (52/101). Most respondents (63.5%, 33/52) do not allow fellows to final sign reports. Of programs that do offer this practice, 36.8% (7/19) have done so for <3 years, 21.1% (4/19) for 3 to 5 years, and 42.1% (8/19) for >5 years. There was no association between fellowship class size or length of fellowship training and final-sign opportunities. Fellow education (84.2%, 16/19) and fellow interest (73.7%, 14/19) were the most common reasons for offering final-sign privileges. Faculty consensus was the main criterion for assessing fellow readiness for graduated autonomy. Of examination types, independent interpretation was most common for diagnostic mammogram and US examinations (36.5%, 19/52), initiated before the last 2 months of fellowship. Approximately 30% (16/52) of respondents allow fellows to perform and final sign procedures, most commonly 5 to 10 months into fellowship training. In 52.6% (10/19) of programs allowing independent reads, no additional compensation is provided.

Most breast imaging fellowship programs do not allow fellows to independently render examination interpretations or perform breast procedures. However, more than half of programs offering fellow autonomy have done so for ≤5 years, suggesting a potential shift in final-sign opportunities.