Practice Management and Health Policy Education in Radiology: An Emerging Imperative

An exclusive health policy education: Original insights from KSA

Objectives

Health policy education is increasingly understood to be an important aspect in preparing future health professionals to become active policy leaders. However, current research on health policy education is limited and has been performed predominantly in Western contexts. The aim of this study was to explore and analyze the state of health policy education in KSA.

Methods

A qualitative document analysis was performed on the course materials of health policy courses offered in Saudi universities. The inductive and interpretive analysis revealed four themes that were finalized after iterative engagement with data and interpretation. The study's credibility was enhanced through negative case analysis and rival explanations.

Results

The results indicated that health policy education was delivered exclusively to specific programs. Whereas health policy courses had specific objectives, the programs’ specialization or the Saudi context influenced the foci of these courses. The varying foci in health policy courses were accompanied by content reflecting the policy process and a discussion of various health policy domains.

Conclusion

The results underscore the importance of building momentum in health policy education and the crucial roles of academic, health and policy leaders. The holistic approach of this study comprehensively indicates the national status of health policy education and situates the ongoing conversation regarding health policy education in a global context.

Leadership Development Programs for Radiology Residents: A Literature Review

PURPOSE

Leadership development has become increasingly important in medical education, including postgraduate training in the specialty of radiology. Since leadership skills may be acquired, there is a need to establish leadership education in radiology residency training. However, there is a paucity of literature examining the design, delivery, and evaluation of such programs. The purpose of this study is to collate and characterize leadership training programs across postgraduate radiology residencies found in the literature.

METHODS

A scoping review was conducted. Relevant articles were identified through a search of Ovid MEDLINE, Ovid EMBASE, Cochrane, PubMed, Scopus, and ERIC databases from inception until June 22, 2020. English-language studies characterizing leadership training programs offered during postgraduate radiology residency were included. A search of the grey literature was completed via a web-based search for target programs within North America.

RESULTS

The literature search yielded 1168 citations, with 6 studies meeting inclusion criteria. Four studies were prospective case series and two were retrospective. There was heterogeneity regarding program structure, content, teaching methodology, and evaluation design. All programs were located in the United States. Outcome metrics and success of the programs was variably reported, with a mix of online and in person feedback used. The grey literature search revealed 3 American-based programs specifically catered to radiology residents, and none within Canada.

CONCLUSION

The review highlighted a paucity of published literature describing leadership development efforts within radiology residency programs. The heterogeneity of programs highlighted the need for guidance from regulatory bodies regarding delivery of leadership curricula.

Relative Prevalence and Characteristics of Malpractice Litigation Involving Radiology Trainees

PURPOSE

To assess the prevalence and characteristics of medical malpractice litigation involving radiology trainees.

METHODS

Using a LexisNexis legal database keyword search, we identified all state and federal lawsuits between 2009 and 2018 yielding formal appellate and lower court opinions (precedent setting "complex litigation") potentially involving physician trainees. Available judicial records were systematically reviewed to identify malpractice matters with material trainee involvement. Cases were categorized by criteria including specialty and location. Incidence rates were calculated for all specialties. Radiology lawsuits were characterized further.

RESULTS

Initial LexisNexis Boolean database search yielded 8,935 potentially relevant cases with 580 confirmed as malpractice materially involving physician trainees. Annual cases trended downward (high 70, low 37). Most originated in New York (195 of 580; 33.6%), Ohio (41; 7.1%), and Pennsylvania (34; 5.9%) and involved surgery (204; 35.2%), obstetrics and gynecology (114; 19.7%), and medicine (105; 18.1%). The case incidence rate for all trainees was 0.63 per 1,000 trainee years. Of 309 cases with known outcomes, defendant physicians prevailed in 238 (77.0%). Radiology trainees represented only 23 cases (4.0%), corresponding to an incidence rate ratio of 0.79 (confidence interval 0.52-1.20). Radiology litigation most frequently involved alleged missed diagnoses (14 of 23; 60.8%) and procedural complications (7; 30.4%). Defendant radiologists prevailed in 9 of the 13 cases with known outcomes (69.2%).

CONCLUSION

Complex medical malpractice litigation involving physician trainees is infrequent and decreasing over time. Lawsuits involving radiology trainees are uncommon, less likely than for many nonradiology trainees, and typically involve alleged missed diagnoses or procedural complications. Defendant radiologists usually prevail.

An Unmet Need in Healthcare Leadership: A Survey of Practicing Physicians' Perspectives on Healthcare Delivery Science Education

Background

Healthcare delivery science education (HDSE) is increasingly needed by physicians balancing clinical care, practice management, and leadership responsibilities in their daily lives. However, most practicing physicians have received little HDSE in undergraduate through residency training. The purpose of this study is to 1) quantify the perception of the need for HDSE and interest in HDSE among a diverse sample of physicians, and 2) determine if perspectives on HDSE vary by specialty, rurality, and years in practice.

Methods

Using a cross-sectional, single state, mailed questionnaire, we surveyed 170 physicians about their perspectives on HDSE and interest in an HDSE program. Descriptive statistics and a multivariable logistic regression are presented.

Results

Among the 70.5% of responding eligible physicians, 75% of physicians had less HDSE than they would like and 90% were interested in obtaining more HDSE. Thirty-five percent of physicians were interested in joining the described HDSE program. The most prevalent barriers to obtaining HDSE were a lack of time and existing programs. Physician perspectives were similar across specialties, years in practice, and rurality.

Conclusion

There is a high unmet need for HDSE among physicians. Diverse and innovative HDSE programming needs to be developed to meet this need. Programming should be developed not only for physicians but also for undergraduate through residency training programs.

Navigating Generational Differences in Radiology

Generations are cohorts of individuals born in a particular time period who share similar values or value systems owing to historic events that occurred at crucial times during their development. Generations are defined to study how views and values change over time and to assess the differential impact that formative experiences have on groups. Understanding and navigating generational differences will be a critical skill for radiology leaders in the coming decade, as four distinct generations are working side by side for the first time in history. The four generations currently in the workforce are categorized as traditionalists, baby boomers, Generation Xers, and millennials. Beginning in 2016, millennials became the largest generation in the U.S. workforce, surpassing the number of Generation Xers. This major demographic shift will have a profound impact on workplace culture, recruitment efforts, and trainee education. While each generation has similar basic needs, meeting those needs and motivating individuals of different generations are best accomplished using different approaches. Radiology leaders must encourage and support these varied generations to work harmoniously to foster high-performance organizations. ^©RSNA, 2018.

Precision Radiology Residency Training: Special Distinction Tracks for Noninterpretative Professional Development

RATIONALE AND OBJECTIVES

The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles.

MATERIALS AND METHODS

Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation.

RESULTS

To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications.

CONCLUSION

The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology.

RVUs, SGR, RUC, and Alphabet Soup: Utility of an iPad App to Teach Healthcare Economics

RATIONALE AND OBJECTIVES

This study aimed to evaluate the effectiveness of an iPad app for teaching healthcare economics milestones.

MATERIALS AND METHODS

Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant survey assessment of radiology residents' knowledge of healthcare economics before and following review of the Healthcare Economics iPad app was undertaken at two residencies. Residents received an electronic link to the pre survey, answered 13 general knowledge questions, rated their knowledge of healthcare economics milestones, and reported any prior economics/business background. During the conference, residents reviewed the app on their iPads. They then received a link to the post survey. Responses were entered using REDCap and a unique yet anonymous code was used to link each resident's pre and post results. A follow-up survey was completed at 3 months using REDCap.

RESULTS

Sixty-two of 69 (90%) residents completed the pre survey. Mean and median age was 30 years. Thirty-two of 62 (52%) were men and 30/62 (48%) were women. Twenty-nine percent (18/62) were postgraduate year (PGY) 2, 24% (15/62) PGY 3, 19% (12/62) PGY 4, 26% (16/62) PGY 5, and 1.6% (1/62) PGY 6. Thirty-four percent (21/62) reported some economics/business background. Residents' mean self-assessment of their knowledge of healthcare economics milestones was fair on the pre survey, significantly improved on the post survey, and plateaued at 3 months. Fifty-nine residents completed the post survey; 60 completed the 3-month follow-up. Residents demonstrated a significant increase in healthcare economics knowledge on post survey. At 3-month follow-up, significant decreases in gained knowledge were observed only in residents for whom the material was not integrated into the curriculum.

CONCLUSIONS

Teaching with iPad apps offers an alternative, effective way to teach basics of healthcare economics milestones.

Radiology Education in the Era of Population-based Medicine in the United States

Over the past several decades, the practice of radiology has undergone substantial change primarily related to advances in imaging technology, changes in the infrastructure of healthcare delivery, and evolution of reimbursement systems. Yet to a large extent, the educational system has not substantially changed. In this perspective, we discuss the need for radiology education to adapt and address these essential systems-based skills (business, quality, informatics, leadership, population-based medicine, and interprofessional teamwork) to ensure that future radiology graduates will thrive in this evolving healthcare environment.