Am I Ready to Be an Independent Neuroradiologist? Objective Trends in Neuroradiology Fellows' Performance during the Fellowship Year

BACKGROUND AND PURPOSE:Aside from basic Accreditation Council for Graduate Medical Education guidelines, few metrics are in place to monitor fellows'' progress. The purpose of this study was to determine objective trends in neuroradiology fellowship training on-call performance during an academic year.MATERIALS AND METHODS:We retrospectively reviewed the number of cross-sectional neuroimaging studies dictated with complete reports by neuroradiology fellows during independent call. Monthly trends in total call cases, report turnaround times, relationships between volume and report turnaround times, and words addended to preliminary reports by attending neuroradiologists were evaluated with regression models. Monthly variation in frequencies of call-discrepancy macros were assessed via χ² tests. Changes in frequencies of specific macro use between fellowship semesters were assessed via serial 2-sample tests of proportions.RESULTS:From 2012 to 2017, for 29 fellows, monthly median report turnaround times significantly decreased during the academic year: July (first month) = 79 minutes (95% CI, 71–86 minutes) and June (12th month) = 55 minutes (95% CI, 52–60 minutes; P value = .023). Monthly report turnaround times were inversely correlated with total volumes for CT (r = –0.70, F = 9.639, P value = .011) but not MR imaging. Words addended to preliminary reports, a surrogate measurement of report clarity, slightly improved and discrepancy rates decreased during the last 6 months of fellowship. A nadir for report turnaround times, discrepancy errors, and words addended to reports was seen in December and January.CONCLUSIONS:Progress through fellowship correlates with a decline in report turnaround times and discrepancy rates for cross-sectional neuroimaging call studies and slight improvement in indirect quantitative measurement of report clarity. These metrics can be tracked throughout the academic year, and the midyear would be a logical time point for programs to assess objective progress of fellows and address any deficiencies.

A fellow''s progress in an academic year is primarily assessed using qualitative, thus subjective, criteria, including achievement of Accreditation Council for Graduate Medical Education–prescribed milestones and faculty evaluations. While the Accreditation Council for Graduate Medical Education provides requirements for total yearly cases read¹ and individual programs may have internal metrics for fellows'' progress, there are no concrete external objective measurements for documenting fellows'' progress within the academic year. Often, fellows are unsure whether their efficiency in generating reports, report turnaround times (RTATs) for on-call examinations, or quality of on-call reports is satisfactory.The total number of studies dictated by the fellow and the RTATs of on-call studies may be reviewed by the attendings and program director with the fellows, but more meaningful interpretation of these numbers is lacking because there are no comparison benchmarks or quantitative checkpoints within the fellowship year. Knowledge of these factors is critical in a fellowship program so that program directors and fellows are jointly aware of progress throughout the year and remediation or additional focused training can be implemented, as necessary. More data on neuroradiology fellowship training are especially needed because a survey in 2016 demonstrated that 25% of practicing neuroradiologists in the United States believe that fellows'' abilities have declined.² Prior studies have analyzed various other factors related to radiology residency training, including total cases read, turnaround time, and on-call accuracy,^3,4 but to our knowledge, no studies have analyzed the quantitative trends in fellowship training during an academic year.We hypothesized that within an academic year, the RTAT for on-call studies dictated by fellows will decrease (ie, improve). Meanwhile, the discrepancy rates will decrease, and clarity of reports will improve. We also hypothesized that participating in independent call will have residual short-term effects on increasing clinical productivity during a subsequent regular work week.     

Factors affecting attending agreement with resident early readings of computed tomography and magnetic resonance imaging of the head, neck, and spine

RATIONALE AND OBJECTIVES: This study examines the joint effect of several factors on radiology resident performance in the task of interpreting after-hours neuroradiology examinations. MATERIALS AND METHODS: As part of a quality assessment process, we conducted a prospective evaluation of all (N = 21,796) after-hours preliminary readings of neuroradiology examinations performed by radiology residents over a 62-month period at our academic medical center. Each reading was scored by the interpreting neuroradiologist as "agree," "disagree with minimal clinical impact," and "disagree with significant clinical impact." Coded resident and attending identities were also recorded for each case along with modality, body area studied, and the date of examination. These raw data were used to create an analytic data set with level of resident/attending agreement as the outcome and six predictors, including two date-derived variables: months 1-62 representing when the case occurred during the study and quartiles 1-4 accounting for the timing of the case in each resident's own experience. Cross tabulations, plots, bivariate statistics, and logistic regression were used to examine the relationships between study variables and the outcome (level of agreement). RESULTS: Over about 5 years of the study, the absolute number of significant disagreements remained stable at about three per month. The total caseload increased at a rate of 4.1 per month with most of the increase falling into the agree category, whereas the minimal disagreements actually decreased slightly (0.2 per month). In the logistic model for disagreement, three of the factors accounted for most of the variance: attending (61%), resident (15%), and month (15%). Study type (modality and area examined) accounted for another 10%. There was no significant contribution from the variable (quartile) constructed to test for individual resident learning during the on-call experience. CONCLUSION: Although residents differ somewhat in the extent of attending agreement with their on-call work, evaluation or remediation made on the basis of simple comparison of these rates should be done with caution. Improved agreement over time seems to be a collective experience shared by residents.     

Part I: preparing first-year radiology residents and assessing their readiness for on-call responsibilities

RATIONALE AND OBJECTIVES: The aim of the study is to evaluate the effectiveness of an Emergency Radiology (ER) Core Curriculum training module and a Digital Imaging and Communications in Medicine (DICOM)-based interactive examination system to prepare first-year (postgraduate year 2 [PGY-2]) radiology residents and assess their readiness for taking overnight radiology call. MATERIALS AND METHODS: Institutional review board approval was obtained, and the study was compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations. A dedicated month-long ER curriculum was designed to prepare new radiology residents for overnight radiology call that includes interpretation of off-hour urgent and emergent studies without immediate direct attending supervision. Lectures of the curriculum, provided by department staff, were based on the American Society of Emergency Radiology core curriculum. The lecture series was implemented after PGY-2 residents had completed formal introductory resident rotations during their first 6 months of training. A DICOM-based interactive computer-based testing module was developed and administered at the end of the lecture series. The module consisted of 19 actual emergency department cases with entire series of images, simulating an on-call setting. Tests were scored by two staff members blinded to resident identifying information. Upper-level residents also were tested, and comparison was made between first-year and upper-level resident test scores to determine the effectiveness of the test in determining first-year resident preparedness for call. Statistical analysis of results was performed by using t-test (P < .05). RESULTS: All residents in the residency program present during the month (nine PGY-2, six PGY-3, seven PGY-4, seven PGY-5 residents) attended the lecture series and finished the testing module at the end of the lecture series. Of 19 actual emergency cases on the testing module, five cases were neuroradiology, three cases were thoracic imaging, eight cases were body imaging, and three cases were musculoskeletal. PGY-2 residents scored an average of 73.0% (range, 63.2%-81.6%) of total points possible. PGY-3 residents scored an average of 76.8% (range, 68.4%-86.8%); PGY-4 residents scored an average of 77.4% (range, 65.8%-100%), and PGY-5 residents scored an average of 81.2% (range, 68.4%-94.7%). There was no statistically significant difference in scores according to level of training. CONCLUSION: First-year radiology residents who underwent 6 months of formal radiology training followed by an intensive ER lecture series before taking overnight call had scores similar to upper-level colleagues on an interactive computer-based ER simulation module.     

Pediatric Emergency Imaging Studies in Academic Radiology Departments: A Nationwide Survey of Staffing Practices

ObjectiveParticularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests.MethodsWe conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher’s exact test and an α of 0.05.ResultsSurveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend.DiscussionA minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care.     

Twenty-four-hour emergency department coverage by attending radiologists

It has been 5 years since we implemented extended attending radiology coverage at the Ohio State Medical Center. This change in our practice has raised several issues including which cases we should report, the effect on resident education, the impact on our circadian rhythm, and scheduling complexity. As a result of this initiative, the quality of care we provide has improved because of a dramatic decrease in report turn-around time and better consultation with our referring physicians.     

Ensuring Appropriateness of Pediatric Second Opinion Consultations

PurposeWe sought to evaluate discrepancy rates between outside interpretations, radiology trainee preliminary reports, and subspecialist attending final interpretations for pediatric second opinion consultations on plain film and computed tomography imaging and to evaluate the impact of a process improvement for second opinion consultations.MethodsOf a total of 572 requests for second opinion consultations during 1-year preintervention period, we utilized RADPEER to score concurrence of 158 requests which occurred overnight and included outside radiologist interpretations and resident preliminary reports. In consultation with clinician committees, we developed new guidelines for requesting second opinion consultations. We evaluated the impact on the number of consultations for the 1-year period following implementation of this process improvement.ResultsThere was concurrence between the outside interpretation and pediatric subspecialist second opinion in 146 of 158 cases (92%). There was concurrence between the radiology resident and pediatric subspecialist second opinion in 145 of 158 cases (92%). During the 1-year period following our process improvement implementation, the total number of second opinion consultations decreased to 185 (from 572, a decrease of 68%) and the number of overnight requests for resident preliminary reports decreased to 11 (from 158, a decrease of 93%).ConclusionsThere was a high degree of concurrence between interpretations provided by outside radiologists, overnight radiology residents, and attending pediatric radiologists at our institution. Analyzing institutional-specific discrepancy rates is a valuable first step in partnering with clinicians to develop appropriate guidelines for second opinion consultations.     

Effects of Changing the Reporting System from Decentralized/Modality-Based to Centralized/Subspecialized Radiology on Radiologists,Radiologic Technicians and Referring Physicians of a Multi-Center Radiology Network

Objectives:To determine the effects of reorganizing a radiology institute from decentralized/modality-based to centralized/subspecialized radiology on radiologists, radiologic technicians, and referring physicians at a multi-center radiology network.Material and Methods:In 2017/2018 our multi-center radiology network was changed from decentralized/modality-based to centralized/subspecialized reporting. A survey was conducted among radiologists, technicians and two groups of referring physicians (main hospital and non-main hospitals). The following items were tested: Overall satisfaction, perceived quality of radiological reports, subjective productivity/efficiency, confidence of radiologists in their subspecialty, availability of radiologists and turnaround time. Two of five answering options on a 5-point Likert scale were considered to represent agreement. The Mann-Whitney-U-test served for statistical analyses in agreement before and after reorganization in each group.Results:For radiologists, a significant difference was observed in perceived quality of radiological reports 42/46 (91.3%) compared to 51/52 (98.1%; p = 0.013).For technicians, no significant differences were observed. In the group of main hospital referring physicians, significant differences were observed in overall satisfaction 129/152 (84.9%) compared to 164/174 (94.3%; p < 0.001) and in perceived quality of radiological reports 125/148 (72.8%) compared to 157/170 (92.4%; p = 0.001). In the group of non-main hospital referring physicians no significant differences were observed.Conclusion:The reorganization resulted in a significantly higher perceived quality of radiological reports for the groups of radiologists and main hospital referring physicians besides overall satisfaction for main hospital referring physicians. Specialized main hospital referring physicians value reports of specialized radiology, whereas less specialized, non-main hospital referring physicians did not experience any significant effect.     

Evaluating the Impact of a Call Triage Assistant on Resident Efficiency,Errors, and Stress

ObjectiveThe aim of this study was to evaluate whether a call triage assistant, who answered telephone calls to the main reading room during the busiest hours of weekend call, would impact resident workflow efficiency, diagnostic errors, and stress level.MethodsThe call triage assistant answered all telephone calls to the main reading room from 12 pm to 7 pm on 6 weekend days over a 3-month period. We compared report turnaround times and resident discrepancy rates on these days with control days, when the same residents were on call without the assistant. We also surveyed residents to determine whether the assistants relieved anxiety associated with the call shift.ResultsWe recorded 168 telephone calls over the study period. We found the majority of telephone calls could be handled by the assistant without disturbing the on-call resident, resulting in a 71% reduction in interruptions. The mean turnaround time for studies read on the days the assistant was on duty was 44.3 min, compared with 75.2 min on the control days (P < .01). Resident major discrepancy rates (0.4% on the intervention days compared to 0.2% on the control days) were similar (P = .58), as were minor discrepancy rates (7.5% on the intervention days compared with 6.7% on the control days; P = .61). Residents reported fewer distractions, improved workflow efficiency, and decreased call-related stress when the assistant was on duty.ConclusionsA call triage assistant effectively improved workflow efficiency and reduced resident stress on call. Resident error rates were unaffected by the presence of the assistant.     

Emergency radiology testing,teaching, and training

Conclusion This article summarizes the training and teaching of radiology residents before they attempt unsupervised emergency call, as reported in the radiologic literature. It is hoped that this report will prompt a serious evaluation of the responsibilities of radiology residents assigned to the emergency center and a reconsideration of the radiologic training and experience provided to radiology residents before they are required to assume these responsibilities. Clearly, education and training in radiology appropriate to the responsibilities expected of the on-call emergency radiology resident are required to assure optimum patient care.     

Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies

RATIONALE AND OBJECTIVES: To determine the incidence of radiology resident preliminary interpretation errors for plain film, body computed tomography, and neuroradiology (neuro)computed tomographic examinations read on call. MATERIALS AND METHODS: We retrospectively reviewed the data in a prospectively acquired resident quality assurance (QA) database dating between January 2000 and March 2007. The database comprises all imaging studies initially interpreted by an on-call resident and later reviewed by a board-certified attending radiologist who determined the level of discrepancy between the two interpretations according to a graded scale from 0 (no discrepancy) to 3 (major discrepancy). We reviewed the data with respect to resident training level, imaging modality, and variance level. Statistical analysis was performed with chi(2) test, alpha = 0.05. We compared our results with other published series studying resident and attending accuracy. RESULTS: A total of 141,381 cases were entered into the database during the review period. Of all examinations, 95.7% had zero variance, 3.3% minor variance, and 1.0% major variance. There was a slight, statistically significant increase in overall accuracy with increased resident year from 95.4% of examinations read by first-year residents (R1s) to 96.1% by fourth-year resident (R4s) (P < .0001). Overall percentages of exams with major discrepancies were 1.0% for R1s, 1.1% for second-year residents, 1.0% for third-year residents, and 0.98% for R4s. CONCLUSIONS: The majority of preliminary resident interpretations are highly accurate. The incidence of major discrepancies is extremely low and similar, even with R1s, to that of attending radiologists published in other studies. A slight, statistically significant decrease in the error rate is detectable as residents gain experience throughout the 4 years of residency.     

On-call radiology 2020: Where trainees look for help in a high stakes and time sensitive environment

BackgroundThe radiology trainee on-call experience has undergone many changes in the past decade. The development of numerous online information sources has changed the landscape of opportunities for trainees seeking information while on-call. In this study, we sought to understand the current on-call information seeking behaviors of radiology trainees.MethodsWe surveyed radiology fellows and residents at three major metropolitan area academic institutions. Survey topics included demographic information, on-call volumes, on-call resource seeking behaviors, preferred first and second line on-call resources and rationale for particular resource usage.ResultsA total of 78 responses from trainees were recorded, 30.5% of the entire surveyed population. 70.5% of trainees preferred Radiopaedia as their first line resource. 26.9% of trainees preferred StatDx as their second line resource. 75.6% of respondents preferred their first line resource because it was easiest and fastest to access. 70.3% of respondents assigned a rating of 4 out of 5 when asked how often information they look for is found while on-call. There was a statistically significant difference according to gender (p = 0.002) with a higher percentage of males listing Radiopaedia as their first line resource compared to females.DiscussionThe radiology trainee on-call experience is influenced by various factors. Over the past decade, online resources, particularly the open access resource Radiopaedia and the paid service StatDx, have overwhelmingly become the preferred first and second line options, as demonstrated by our study results.     

From Being a Radiologist to Watching a Radiologist: Impact of Filmless Operation on the Training of Radiology Residents

RATIONALE AND OBJECTIVES: The authors performed this study to investigate the impact of changing from a film-based image interpretation system to one using digital image workstations on the training of radiology residents in the interpretation of radiographs. MATERIALS AND METHODS: Data were collected during a period when a conventional system of image interpretation with hard-copy images and multiviewers was used and during a period when digital image workstations were used. During each period, it was noted whether the first interpretation of the radiographs was performed by a radiology resident, by an attending radiologist, or as a group effort including both an attending radiologist and a radiology resident(s). In addition, it was noted whether a radiology resident or an attending radiologist dictated the report. RESULTS: The proportion of images first interpreted by the radiology resident alone decreased from 38% (53 of 139) when using the conventional system to 17% (34 of 199) after the switch to interpreting images on the workstations (P = .001). During the film-based period, radiology residents dictated 45% of reports (141 of 312), but during the workstation period, radiology residents dictated only 4% of reports (24 of 667; P = .001). CONCLUSION: The authors observed a decrease in autonomous participation by radiology residents in image interpretation and dictation of reports and an increase in "group reading" after the switch from a film-based system to a workstation system.     

Resident bullying in diagnostic radiology

PurposeWorkplace bullying has been reported in multiple medical specialties outside of diagnostic radiology within the United States. The purpose of this study was to survey diagnostic radiology residents in the United States to determine if: (1) residents had experienced bullying, (2) residents had witnessed bullying of other residents, (3) residents were aware of zero-tolerance policy for workplace bullying at their institution, (4) residents were aware of no retaliation policies for reporting bullying at their institution.Materials and methodsIn December 2017, a weekly E-mail for 4 weeks was sent to diagnostic radiology residents in the United States (residents) who had attended the July 2017, September 2017 and October 2017 4-week American Institute for Radiologic Pathology (AIRP) resident course to participate in an online, anonymous, voluntary survey.Results28% of radiology resident respondents reported workplace bullying during their residency. One third of radiology residents have witnessed workplace bullying of another radiology resident at their facility. Approximately one half (48%) of respondents did not know if their institution had a zero-tolerance policy for workplace bullying, and approximately one half (55%) of respondents did not know if their institution had a no retaliation policy for reporting workplace bullying.ConclusionOur survey of diagnostic radiology residents across the United States confirms workplace bullying during residency, and the opportunity for implementation of zero-tolerance and zero retaliation policies for reporting workplace bullying in residency training institutions.     

Comparing Preliminary and Final Neuroradiology Reports: What Factors Determine the Differences?

BACKGROUND AND PURPOSE:Trainees'' interpretations of neuroradiologic studies are finalized by faculty neuroradiologists. We aimed to identify the factors that determine the degree to which the preliminary reports are modified.MATERIALS AND METHODS:The character length of the preliminary and final reports and the percentage character change between the 2 reports were determined for neuroradiology reports composed during November 2012 to October 2013. Examination time, critical finding flag, missed critical finding flag, trainee level, faculty experience, imaging technique, and native-versus-non-native speaker status of the reader were collected. Multivariable linear regression models were used to evaluate the association between mean percentage character change and the various factors.RESULTS:Of 34,661 reports, 2322 (6.7%) were read by radiology residents year 1; 4429 (12.8%), by radiology residents year 2; 3663 (10.6%), by radiology residents year 3; 2249 (6.5%), by radiology residents year 4; and 21,998 (63.5%), by fellows. The overall mean percentage character change was 14.8% (range, 0%–701.8%; median, 6.6%). Mean percentage character change increased for a missed critical finding (+41.6%, P < .0001), critical finding flag (+1.8%, P < .001), MR imaging studies (+3.6%, P < .001), and non-native trainees (+4.2%, P = .018). Compared with radiology residents year 1, radiology residents year 2 (−5.4%, P = .002), radiology residents year 3 (−5.9%, P = .002), radiology residents year 4 (−8.2%, P < .001), and fellows (−8.7%; P < .001) had a decreased mean percentage character change. Senior faculty had a lower mean percentage character change (−6.88%, P < .001). Examination time and non-native faculty did not affect mean percentage character change.CONCLUSIONS:A missed critical finding, critical finding flag, MR imaging technique, trainee level, faculty experience level, and non-native-trainee status are associated with a higher degree of modification of a preliminary report. Understanding the factors that influence the extent of report revisions could improve the quality of report generation and trainee education.

Understanding the prevalence, causes, and types of discrepancies and errors in examination interpretation is a critical step in improving the quality of radiology reports. In an academic setting, discrepancies and errors can result from nonuniform training levels of residents and fellows. However, even the “experts” err, and a prior study found a 2.0% clinically significant discrepancy rate among academic neuroradiologists.¹ A number of factors can affect the accuracy of radiology reports. One variable of interest at teaching hospitals is the effect of the involvement of trainees on discrepancies in radiology reports. Researchers have found that compared with studies read by faculty alone, the rate of clinically significant detection or interpretation error was 26% higher when studies were initially reviewed by residents, and it was 8% lower when the studies were initially interpreted by fellows.² These findings suggest that perhaps faculty placed too much trust in resident interpretations, which led to a higher rate of discrepancies, while on the other hand, having a second experienced neuroradiology fellow look at a case can help in reducing the error rate.²In our academic setting, preliminary reports initially created by trainees are subsequently reviewed and finalized by faculty or staff. The changes made to preliminary reports are a valuable teaching tool for trainees because clear and accurate report writing is a critical skill for a radiologist.³ Recently, computer-based tools have been created to help trainees compare the changes between preliminary and final reports to improve their clinical skills and to facilitate their learning. Sharpe et al⁴ described the implementation of a Radiology Report Comparator, which allows trainees to view a merged preliminary/final report with all the insertions and deletions highlighted in “tracking” mode. Surrey et al⁵ proposed using the Levenshtein percentage or percentage character change (PCC) between preliminary and final reports as a quantitative method of indirectly assessing the quality of preliminary reports and trainee performance. The Levenshtein percentage, a metric used in computer science, compares 2 texts by calculating the total number of single-character changes between the 2 documents, divided by the total character count in the final text.⁵In this study, we analyzed preliminary neuroradiology reports dictated by trainees and the subsequent finalized reports revised by our faculty. We set out to identify the factors that determine the degree to which the preliminary reports are modified by faculty for residents and fellows, for daytime and nighttime shifts, and for CT and MR imaging examinations. We hypothesized that study complexity, lack of experience (for both trainee and faculty), and perhaps limited language skills (native-versus-non-native speaker) would result in a greater number of corrections.     

Resident vs. attending interpretation of on-call studies: clinical impact

Purpose: This study was performed to determine whether significant changes to patient treatment plan or outcome result from discrepancies between on-call radiology residents and follow-up attending radiologists in their interpretation of examinations. Methods: For 70 days we recorded on-call radiology residents' readings of all computed tomography and ultrasound examinations performed in our institution and the follow-up attending radiologists' readings of these same examinations. A chart review was performed to determine whether interpretation discrepancies changed the treatment plan and clinical outcome. Results: Eight-hundred thirty-four examinations met the study guidelines. The overall discrepancy rate was 5.16 %. Of these discrepancies, 6.98 % affected the treatment plan (0.36 % of all 834 studies) and none affected the clinical outcome. Conclusion: Where there is a discrepancy between interpretation of computed tomography and ultrasound after hours by on-call radiology residents and follow-up readings by attending radiologists, this discrepancy has no significant effect on the immediate or long-term care of patients.     

Radiology Resident Preliminary Reporting in an Independent Call Environment: Multiyear Assessment of Volume,Timeliness, and Accuracy

PurposeThe objective of this paper is to assess the volume, accuracy, and timeliness of radiology resident preliminary reports as part of an independent call system. This study seeks to understand the relationship between resident year in training, study modality, and discrepancy rate.MethodsResident preliminary interpretations on radiographs, ultrasound, CT, and MRI from October 2009 through December 2013 were prospectively scored by faculty on a modified RADPEER scoring system. Discrepancy rates were evaluated based on postgraduate year of the resident and the study modality. Turnaround times for reports were also reviewed. Differences between groups were compared with a chi-square test with a significance level of 0.05. Institutional review board approval was waived as only deidentified data were used in the study.ResultsA total of 416,413 studies were reported by 93 residents, yielding 135,902 resident scores. The rate of major resident–faculty assessment discrepancies was 1.7%. Discrepancy rates improved with increasing experience, both overall (PGY-3: 1.8%, PGY-4: 1.7%, PGY-5: 1.5%) and for each individual modality. Discrepancy rates were highest for MR (3.7%), followed by CT (2.4%), radiographs (1.4%), and ultrasound (0.6%). Emergency department report turnaround time averaged 31.7 min. The average graduating resident has been scored on 2,746 ± 267 reports during residency.ConclusionsResident preliminary reports have a low rate of major discrepancies, which improves over 3 years of call-taking experience. Although more complex cross-sectional studies have slightly higher discrepancy rates, discrepancies were still within the range of faculty report variation.     

On-Call Radiology Resident Discrepancies: Categorization by Patient Location and Severity

PurposeTo report discrepancy rates for examinations interpreted by on-call residents overall and by resident training level, and to describe a novel discrepancy classification system based on patient location and severity that facilitates recording of discrepancy data, helps ensure proper communication of report changes, and allows our radiology department to assume responsibility for contacting discharged patients with non-time-dependent results.MethodsA HIPAA-compliant, institutional review board–exempt review of two years (January 2013 to December 2014) of discrepancy data was retrospectively performed for total number of examination interpreted, discrepancy rates, resident training level, and discrepancy categories. Most common diagnoses and means of results communication for discharged patients were also recorded.ResultsRadiology residents interpreted 153,420 examinations after hours and had 2169 discrepancies, for an overall discrepancy rate of 1.4%. Discrepancy rates for postgraduate year (PGY)-3, PGY-4, and PGY-5 residents were 1.31%, 1.65%, and 1.88%, respectively. The rate of critical discrepancies was extremely low (10/153,420 or 0.007%). A total of 502 patients (23.2% of all discrepancies) were discharged at the time their discrepancy was identified, 60% of whom had non-time-dependent discrepancies that were communicated by radiologists; 32.4% of these had addended results telephoned to a PCP, 43.4% had addended results telephoned to the patient, and the remaining 24.2% required a registered letter. Eight percent of patients with non-time-dependent findings were lost to follow-up.ConclusionsOur resident discrepancy rates were comparable to those published previously, with extremely low rates of critical discrepancies. Radiologists assumed responsibility for contacting the majority of discharged patients with discrepant results, a minority of whom were lost to follow-up.     

Results of and comments on the 2000 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES: The American Association of Academic Chief Residents in Radiology (A3CR2) annually surveys radiology residency programs on issues related to training. The objective is to highlight national similarities, differences, and trends to help programs establish standards and improve residency training. MATERIALS AND METHODS: Questionnaires were mailed to 180 accredited diagnostic radiology residency training programs in the United States. The survey covered the usual general topics and more specific topics considered every 4 years; for 2000 the latter were on-call issues and the chief residency year. RESULTS: Completed surveys were returned from 63 programs (35%). Important findings included increased caseload and call commitments, especially for smaller programs. Resident salaries appear to have increased more than the consumer price index. Nonemergent after-hour coverage and teleradiology are now a large part of the resident work practice. Women continue to be underrepresented, with a trend downward. Chief residents are more involved in organizing preparation for board examinations and have greater office facilities and more administrative duties. CONCLUSION: This survey provided useful insights. All levels of residency face increased workloads. On-call hours have not changed, but the work has intensified and the use of teleradiology has increased. Many programs have adopted a "night-float" system, and nonemergent after-hours coverage should be considered in any program evaluation. Continued vigilance and sustained efforts are required to ensure that radiology is considered as a specialty by both men and women. With increased demands on attending physicians' time, chief residents may need to take on more administrative responsibilities.