Peer Learning Through Multi-Institutional Case Conferences: Abdominal and Cardiothoracic Radiology Experience

The Role of Twitter in Radiology Medical Education and Research: A Review of Current Practices and Drawbacks

The trends in society have provided favourable conditions for the rapid growth of radiology on social media, specifically there has been an expanding presence on Twitter. Currently, simple searches on Twitter yield a plethora of radiology education resources, that may be suited for medical students, residents or practicing radiologists. Educators have many tools at their disposal to deliver effective teaching. Over time, strategies such as including images and scrollable stacks often are more successful at gaining popularity or clicks online. Journals and authors can use Twitter to promote their new scientific work and potentially reach audiences they couldn't have prior. Attendees at conferences can get involved in the conversation by tweeting about the meeting and engaging with other attendees with mutual interests. Interested medical students, residents and even practicing radiologists can use Twitter as a means of networking and connecting with other scholars all around the globe. Within its glory, Twitter does carry some drawbacks including privacy concerns, equality, and risk of misinformation. Above all, the future of Twitter is bright and promising for all who are currently on it and plan to use it for their education, research, or professional advancement.

Peer learning is both preferable and less expensive than score-based peer review: Initial experience at a tertiary academic center

PURPOSE

To examine radiologist experiences and perceptions during a transition from score-based peer review to a peer learning program, and to assess differences in time-cost efficiency between the two models of quality improvement.

METHODS

Differences in Likert scale survey responses from radiologists (N = 27) in a multispecialty group at a single tertiary academic center before and following intervention were evaluated by Mann-Whitney U test. Multiple variable linear regression analysis assessed independent variables and program preference.

RESULTS

All positive impacts rated significantly higher for the peer learning program. Workflow disruption for the peer learning program rated significantly lower. 70.4 % (19 of 27) preferred the new program, and 25.9 % (7 of 27) preferred the old program. Only the "worth investment" questionnaire score demonstrated a significant correlation to program preference and with an effect that was greatest among all variables (Beta = 1.11, p = 0.02). There was a significantly decreased amount of time per month used to complete peer learning exercises (0.76 ± 0.45 h, N = 27) versus peer review exercises (1.71 ± 1.84 h, N = 34, p = 0.011). The result was a difference of 0.95 ± 1.89 h/month (11.4 ± 22.7 h/year), translating to an estimated direct salary time-cost saving of $1653.68/year/radiologists and a direct productivity time-cost saving of $3469.39/year/radiologist when utilizing the peer learning program.

CONCLUSIONS

There was a strongly positive perception of the new peer learning program. There was a substantial implied direct time-cost saving from the transition to the peer learning program.

PRECIS

The peer learning model emphasizes learning from errors via feedback in a non-punitive environment. This model was positively perceived and demonstrated substantial implied direct time-cost saving.

Peer learning in abdominal radiology: iterative process improvements over a 20-year experience

PURPOSE

After a slow and challenging transition period, peer learning and improvement (PLI) is now being more widely adopted by practices as an option for continuous personal and practice performance improvement. In addition to gaps that exist in the understanding of what PLI is and how it should be practiced, wide variation exists in how the process is implemented, administered, how outcomes are measured, and what strategies are employed to engage radiologists. This report aims to describe lessons learned from our 20-year experience with the design, implementation, and continuous improvements of a PLI program in a large academic program.

METHODS

Since initial implementation in 2004, an oversight team prospectively documented iterative process improvements and data submission trends in our PLI process. Process data included strategies for engaging radiologists in the PLI process (fostering case submission, PLI meeting participation), steps for achieving regulatory compliance, and template content for facilitating the value and impact of PLI meetings (case analysis, review of contributing factors, identification of improvement opportunities).

RESULTS

Submission trends, submitted case content, and improvement opportunities varied by clinical section. Process improvements that fostered engagement included closing the loop with participants, expanding criteria for case submission beyond interpretive disagreements (e.g., great pickups, near misses), minimizing impacts to workflow, and using evidence-based templates for case and contributor categorization, bias analysis, and identification of improvement opportunities.

CONCLUSION

Implementing an effective PLI program requires sustained communication, education, and continuous process improvement. While PLI can certainly lead to process and individual performance improvement, the program requires trained champions, designated time, effort, resources, education, and patience to be effectively implemented.

Interventional Radiology Peer Learning Platform and Adverse Event Reporting (IR-PEER): Initial Experience Implementing a Team-based Novel Peer Learning System in Interventional Radiology

Although the transition from peer review to peer learning has had favorable outcomes in diagnostic radiology, experience with implementing a team-based peer review system in interventional radiology (IR) remains limited. Peer learning systems benefit diverse IR teams composed of multiple clinical roles and could contribute value in archiving events that have potential educational value. With multiple stakeholder input from clinical roles within the IR division at our institution (ie, radiologic technologists, nurses, advanced practice providers, residents, fellows, and attending physicians), we launched a HIPAA-compliant secure IR complication and learning opportunity reporting platform in April 2022. Case submissions were monitored over the subsequent 24 weeks, with monthly dashboard reports provided to departmental leadership. Preintervention and postintervention surveys were used to assess the impact of the peer learning platform and adverse event reporting in IR (IR-PEER) on perceptions of complication reporting in the IR division across clinical roles. Ninety-two peer learning submissions were collected for a weekly average ± standard error of 3.8 ± 0.6 submissions per week, and an additional 26 submissions were collected as part of the division's ongoing monthly complication review conference, for a total of 98 unique total case references. A total of 64.1% of submissions (59 of 92) involved a complication and/or adverse event, and 35.9% of submissions (33 of 92) identified a learning opportunity (no complication or adverse event). Nurses reported that IR-PEER made the complication-reporting process easier (P = .01), and all clinical roles reported that IR-PEER improved the overall process of complication reporting. Peer learning frameworks such as IR-PEER provide a more equitable communication platform for multidisciplinary teams to capture and archive learning opportunities that support quality and safety improvement efforts.

Teaching with Technology-Matching Pedagogy with Purpose in Radiology Education

The response to pandemic-related teaching disruption has revealed dynamic levels of learning and teaching flexibility and rapid technology adoption of radiology educators and trainees. Shutdowns and distancing requirements accelerated the adoption of technology as an educational tool, in some instances supplanting in-person education entirely. Despite the limitations of remote interaction, many educational advantages were recognized that can be leveraged in developing distance learning paradigms. The specific strategies employed should match modern learning science, enabling both students and educators to mutually grow as lifelong learners. As panel members of the "COVID: Faculty perspective" Task Force of the Association of University Radiologists Radiology Research Alliance, we present a review of key learning principles which educators can use to identify techniques that enhance resident learning and present an organized framework for applying technology-aided techniques aligned with modern learning principles. Our aim is to facilitate the purposeful integration of learning tools into the training environment by matching these tools to established educational frameworks. With these frameworks in mind, radiology educators have the opportunity to re-think the balance between traditional curricular design and modern digital teaching tools and models.

Peer Learning Program Metrics: A Pediatric Neuroradiology Example

BACKGROUND AND PURPOSE

The American College of Radiology is now offering an accreditation pathway for programs that use peer learning. Here, we share feasibility and outcome data from a pilot peer learning program in a pediatric neuroradiology section that, in its design, follows the American College of Radiology peer learning accreditation pathway criteria.

MATERIALS AND METHODS

We retrospectively reviewed metrics from a peer learning program with 5 participating full-time pediatric neuroradiologists during 1 year: 1) number of cases submitted, 2) percentage of radiologists meeting targets, 3) monthly attendance, 4) number of cases reviewed, 5) learning points, and 6) improvement actions. In addition, a faculty survey was conducted and is reported here.

RESULTS

Three hundred twenty-four cases were submitted (mean, 7 cases/faculty/month). The faculty never met the monthly submission target. Peer learning meeting attendance was 100%. One hundred seventy-nine cases were reviewed during the peer learning meetings. There were 22 learning points throughout the year and 30 documented improvement actions. The faculty survey yielded the highest ratings (4.8 of 5) for ease of meeting the 100% attendance requirement and for the learning value of the peer learning sessions. The lowest rating (4.2 of 5) was given for the effectiveness of improvements as a result of peer learning discussions.

CONCLUSIONS

Implementing a peer learning program that follows the American College of Radiology peer learning accreditation pathway criteria is feasible. Program metric documentation can be time-consuming. Participant feedback led to meaningful program improvement, such as improving trust, expanding case submission categories, and delegating tasks to administrative staff. Effort to make peer learning operations more efficient and more effective is underway.

Peer learning in emergency radiology: effects on learning, error identification, and radiologist experience

PURPOSE

We established and evaluated a peer learning program in an emergency radiology (ER) division. Peer learning is an alternative to peer review focusing on non-punitive error reporting to mitigate consequences of inevitable human error. The central component is the peer learning conference, where cases are presented, key teaching points are discussed, and process improvement ideas are solicited.

METHODS

We established a prior imaging-based case identification system and a bimonthly remote videoconference where ER faculty discuss 5-15 cases selected for learning or process improvement opportunities. Case identification and conference characteristics were captured. A survey focused on learning and performance outcomes was administered to faculty initially and showed improved scores after 6 months.

RESULTS

Cases selected for conference favored perception errors (46%), with great calls (17%) and process improvement (15%) the next most common categories. A variety of anatomical regions were represented, with abdominal (35%) and musculoskeletal (29%) most common. Error detection was improved over peer review. All participants find the system easy to use and prefer peer learning to peer review for learning and process improvement.

CONCLUSION

A peer learning program can be successfully implemented within a busy academic emergency radiology division, as evidenced by increasing buy-in and engagement scores over time. When tied to a departmental peer learning infrastructure, interdisciplinary expertise and robust case identification can be leveraged to increase learning opportunities.

Lessons Learned from Peer Learning Conference in Cardiothoracic Radiology

Medical errors may lead to patient harm and may also have a devastating effect on medical providers, who may suffer from guilt and the personal impact of a given error (second victim experience). While it is important to recognize and remedy errors, it should be done in a way that leads to long-standing practice improvement and focuses on systems-level opportunities rather than in a punitive fashion. Traditional peer review systems are score based and have some undesirable attributes. The authors discuss the differences between traditional peer review systems and peer learning approaches and offer practical suggestions for transitioning to peer learning conferences. Peer learning conferences focus on learning opportunities and embrace errors as an opportunity to learn. The authors also discuss various types and sources of errors relevant to the practice of radiology and how discussions in peer learning conferences can lead to widespread system improvement. In the authors' experience, these strategies have resulted in practice improvement not only at a division level in radiology but in a broader multidisciplinary setting as well. The online slide presentation from the RSNA Annual Meeting is available for this article. ^©RSNA, 2022.

Role of social and non-social online media: how to properly leverage your internet presence for professional development and research

The internet has become an integral component of daily life, with its content broadly grouped into social media and non-social online content. The use of social media, comprising interactive information sharing and networking tools, has proliferated in radiology, with as many as 85% of radiologists utilizing social media and adoption by both private and academic practices. In radiology, social media has been used to increase patient and public awareness of the specialty, establish a professional brand, share scholarly activity, aid in professional development and recruitment, improve communication, and increase engagement during scientific meetings. Organizations like the Society of Abdominal Radiology have increased the visibility of abdominal and pelvic radiology through their activity on social media; however, individual radiologists are integral to this function as well. In this article, we outline a stepwise approach to the individual use of social media, with practical tips for radiologists interested in effectively engaging the plethora of social media and non-social online content available. We also briefly discuss an approach to performing research using publicly available online media.

Incorporating Peer Learning Into Your Breast Imaging Practice

Traditional score-based peer review has come under scrutiny in recent years, as studies have demonstrated it to be generally ineffective at improving quality. Many practices and programs are transitioning to a peer learning model to replace or supplement traditional peer review. Peer learning differs from traditional score-based peer review in that the emphasis is on sharing learning opportunities and creating an environment that fosters discussion of errors in a nonpunitive forum with the goal of improved patient care. Creating a just culture is central to fostering successful peer learning. In a just culture, mistakes can be discussed without shame or fear of retribution and the focus is on systems improvement rather than individual blame. Peer learning, as it pertains to breast imaging, can occur in many forms and venues. Examples of the various formats in which peer learning can occur include through individual colleague interaction, as well as divisional, multidisciplinary, department-wide, and virtual conferences, and with the assistance of artificial intelligence. Incorporating peer learning into the practice of breast imaging aims to reduce delayed diagnoses of breast cancer and optimize patient care.

Diagnosis in a snap: a pilot study using Snapchat in radiologic didactics

Purpose

To evaluate Snapchat, an image-based social media platform, as a tool for emergency radiologic didactics comparing image interpretation on mobile devices with conventional analysis on a classroom screen.

Materials and methods

Seven radiology residents (4 juniors, 3 seniors;4 males, 3 females; 28.4 years old, ± 1.7 years) were shown 5 emergent radiologic cases using Snapchat and 5 cases of similar content and duration on a classroom projector over 4 weeks. All images depicted diagnoses requiring immediate communication to ordering physicians. Performance was scored 0–2 (0 = complete miss, 1 = major finding, but missed the diagnosis, 2 = correct diagnosis) by two attending radiologists in consensus.

Results

All residents performed better on Snapchat each week. In weeks 1–4, juniors scored 21/40 (52.5%), 23/40 (57.5%), 19/40 (47.5%), and 18/40 (45%) points using Snapchat compared with 13/40 (32.5%), 23/40 (57.5%), 14/40 (35%), and 13/40 (32.5%), respectively, each week by projector, while seniors scored 19/30 (63.3%), 21/30 (70%), 27/30 (90%), and 21/30 (70%) on Snapchat versus 16/30 (53.3%), 19/30 (63.3%), 20/30 (66.7%), and 20/30 (66.7%) on projector. Four-week totals showed juniors scoring 81/160 (50.6%) on Snapchat and 63/160 (39.4%) by projector compared with seniors scoring 88/120 (73.3%) and 75/120 (62.5%), respectively. Performance on Snapchat was statistically, significantly better than via projector during weeks 1 and 3 (p values 0.0019 and 0.0031).

Conclusion

Radiology residents interpreting emergency cases via Snapchat showed higher accuracy compared with using a traditional classroom screen. This pilot study suggests that Snapchat may have a role in the digital radiologic classroom’s evolution.