Transitioning From Peer Review to Peer Learning: Report of the 2020 Peer Learning Summit

Reinterpretation of Hepatopancreaticobiliary Imaging Exams: Assessment of Clinical Impact, Peer Learning, and Physician Satisfaction

OBJECTIVES

To assess the impact on clinical management, potential for peer learning, and referring physician satisfaction with subspecialist reinterpretations of hepatopancreaticobiliary (HPB) imaging examinations.

MATERIALS AND METHODS

HPB CTs and MRIs from outside hospitals were reinterpreted by two subspecialty radiologists between March 2021 and August 2022. Reinterpretation reports were mailed to radiologists that issued primary reports. The electronic record was reviewed to assess for changes in clinical management based on the reinterpretations (yes/no/unavailable). To assess the potential for peer learning, a survey using a 5-point Likert scale was sent to radiologists who issued primary reports. A separate survey was sent to referring physicians to assess satisfaction with reinterpretations.

RESULTS

Two hundred fifty imaging examinations (122 CT, 128 MRI) were reinterpreted at the request of 19 referring physicians. Ninety-six radiologists issued primary reports. RADPEER scores 1-3 were assigned to 131/250 (52%), 86/250 (34%), and 33/250 (13%) examinations, respectively. Of 213 reinterpretations with adequate records for assessment, 75/213 (35%) were associated with a change in management; of these, 71/75 (95%) were classified as RADPEER 2 or 3. Most radiologists agreed or strongly agreed with the following: prefer to receive reinterpretations (34/36, 94%); reinterpretations changed practice of reporting HPB imaging examinations (23/36, 64%); and reinterpretations offer opportunities for peer learning (34/36, 94%). Referring physicians agreed or strongly agreed (7/7, 100%) that reinterpretations are valuable and often change or clarify management of patients with complex HPB disease, and offer an opportunity for peer learning.

CONCLUSION

Radiologists and referring physicians strongly agree that HPB imaging reinterpretations help support peer learning and patient management, respectively.

Frequency and classification of addenda in paediatric neuroradiological reports as part of quality assurance

AIM

To determine the frequency and classification of addenda seen in paediatric brain magnetic resonance imaging (MRI) reports.

MATERIALS AND METHODS

A retrospective review of the addenda of brain MRI reports from a large tertiary children's hospital was undertaken between January 2013 to December 2021 and a subset of above radiology reports was used to classify addenda over 6-month periods, October to March, spanning 2018 to 2021. A radiology fellow and a medical doctor classified the addenda into previously published categories using their best judgement.

RESULTS

Out of 73,643 brain MRI reports over 9 years (108 months) included in the study, only 923 reports (1.25%) had addenda. There was a total of 13,615 brain MRI reports from 6-month periods, of which only 179 reports (1.31%) had an addendum. The number of errors according to categories were: observational 88/13,615 (0.65%); interpretational 16/13,615 (0.12%); non-observational and non-interpretative 82/13,615 (0.6%). Notifications to referring physician made in 29/13,615 (0.21%).

CONCLUSIONS

The overall proportion of addenda to the brain MRI reports of children in the present study was low, at 1.25%. Categorisation of different addenda revealed the most common errors to be observational in 0.65%, including under-reading in the region of interest in 0.25%. Appropriate measures can now be introduced to minimise the error-based addenda further and improve MRI diagnosis in children. Other paediatric practices may choose to follow suit in evaluating their addenda and errors to improve practice.

Event-Based Learning and Improvement: Radiology's Move From Peer Review to Peer Learning

Over the past 15 years, the radiology community has made great progress moving from a system of score-based peer review to one of peer learning. Much has been learned along the way. In peer learning, cases in which learning opportunities are identified are reviewed solely for the purpose of fostering learning and improvement. This article defines peer learning and peer review and emphasizes the difference; looks back at the 20-year history of score-based peer review and transition to peer learning; outlines the problems with score-based peer review and the key elements of peer learning; discusses the current state of peer learning; and outlines future challenges and opportunities.

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.

DXA Reporting Updates: 2023 Official Positions of the International Society for Clinical Densitometry

INTRODUCTION

Professional guidance and standards assist radiologic interpreters in generating high quality reports. Initially DXA reporting Official Positions were provided by the ISCD in 2003; however, as the field has progressed, some of the current recommendations require revision and updating. This manuscript details the research approach and provides updated DXA reporting guidance.

METHODS

Key Questions were proposed by ISCD established protocols and approved by the Position Development Conference Steering Committee. Literature related to each question was accumulated by searching PubMed, and existing guidelines from other organizations were extracted from websites. Modifications and additions to the ISCD Official Positions were determined by an expert panel after reviewing the Task Force proposals and position papers.

RESULTS

Since most DXA is now performed in radiology departments, an approach was endorsed that better aligns with standard radiologic reports. To achieve this, reporting elements were divided into required minimum or optional. Collectively, required components comprise a standard diagnostic report and are considered the minimum necessary to generate an acceptable report. Additional elements were retained and categorized as optional. These optional components were considered relevant but tailored to a consultative, clinically oriented report. Although this information is beneficial, not all interpreters have access to sufficient clinical information, or may not have the clinical expertise to expand beyond a diagnostic report. Consequently, these are not required for an acceptable report.

CONCLUSION

These updated ISCD positions conform with the DXA field's evolution over the past 20 years. Specifically, a basic diagnostic report better aligns with radiology standards, and additional elements (which are valued by treating clinicians) remain acceptable but are optional and not required. Additionally, reporting guidance for newer elements such as fracture risk assessment are incorporated. It is our expectation that these updated Official Positions will improve compliance with required standards and generate high quality DXA reports that are valuable to the recipient clinician and contribute to best patient care.

The Joint Commission's Ongoing Professional Practice Evaluation Process: Costly, Ineffective, and Potentially Harmful to Safety Culture

OBJECTIVE

To evaluate the estimated labor costs and effectiveness of Ongoing Professional Practice Evaluation (OPPE) processes at identifying outlier performers in a large sample of providers across multiple health care systems and to extrapolate costs and effectiveness nationally.

METHODS

Six hospital systems partnered to evaluate their labor expenses related to conducting OPPE. Estimates for mean labor hours and wages were created for the following: data analysts, medical staff office professionals, department physician leaders, and administrative assistants. The total number of outlier performers who were identified by OPPE metrics alone and that resulted in lack of renewal, limitation, or revoking of hospital privileges during the past annual OPPE cycle (2022) was recorded. National costs of OPPE were extrapolated. Literature review of the effect of OPPE on safety culture in radiology was performed.

RESULTS

The evaluated systems had 12,854 privileged providers evaluated by OPPE. The total estimated annual recurring labor cost per provider was $50.20. Zero of 12,854 providers evaluated were identified as outlier performers solely through the OPPE process. The total estimated annual recurring cost of administering OPPE nationally was $78.54 million. In radiology over the past 15 years, the use of error rates based on score-based peer review as an OPPE metric has been perceived as punitive and had an adverse effect on safety culture.

CONCLUSION

OPPE is expensive to administer, inefficient at identifying outlier performers, diverts human resources away from potentially more effective improvement work, and has been associated with an adverse impact on safety culture in radiology.

Get With the Guidelines on MS Imaging by Leveraging Peer Learning

OBJECTIVES

To achieve consensus on the performance, interpretation and reporting of MS imaging according to up-to-date guidelines using the Peer Learning Methodology.

MATERIALS AND METHODS

We utilized the Peer Learning Methodology to engage our clinical and radiology colleagues, review the current guidelines, acheive consensus on imaging techniques and reporting standards. After implementing changes, we collected radiologist feedback on the impact of the optimized images on their interpretation.

RESULTS

Survey responders indicated a strong preference for the new protocol in terms of overall image quality, individual lesions conspicuity and confidence in the ability to detect an MS lesion. The new protocol was preferred for both MS diagnosis and MS surveillance in 25 of 28 responses.

CONCLUSION

The Peer Learning Methodology is an effective tool to standardize and improve MR imaging quality, interpretation and reporting for Multiple Sclerosis in accordance with current guidelines.

Transition from Peer Review to Peer Learning: Lessons Learned

Landmark publications, such as To Err is Human, confronted the healthcare community with the egregious toll medical errors played in both patient safety and overall healthcare costs. This heralded a paradigm shift and a call for action by professional organizations to enact methods to ensure physician competency and quality assurance. The American College of Radiology similarly convened a task force to discuss these concerns and how best to address quality assurance in radiology practice, leading to the development of RADPEER, a score-based peer review system. However, critics were quick to point out the deficiencies of this model, highlighting it as punitive and a poor evaluator of physician performance. The recognized deficiencies in score-based peer review prompted the pursuit of an alternate model that would instead emphasize learning and improvement. Peer learning was proposed and highlighted the necessity of an inclusive and collaborative environment where colleagues could discuss case errors as learning opportunities without fear of punitive consequence. This paper explores peer learning, its benefits and challenges, as well as how to identify specific learning opportunities by utilizing case examples.

Frequency and Clinical Utility of Alerts for Intra-Institutional Radiologist Discrepant Opinions

OBJECTIVE

Determine the rate of documented notification, via an alert, for intra-institutional discrepant radiologist opinions and addended reports and resulting clinical management changes.

METHODS

This institutional review board-exempt, retrospective study was performed at a large academic medical center. We defined an intra-institutional discrepant opinion as when a consultant radiologist provides a different interpretation from that formally rendered by a colleague at our institution. We implemented a discrepant opinion policy requiring closed-loop notification of the consulting radiologist's second opinion to the original radiologist, who must acknowledge this alert within 30 days. This study included all discrepant opinion alerts created December 1, 2019, to December 31, 2021, of which two radiologists and an internal medicine physician performed consensus review. Primary outcomes were degree of discrepancy and percent of discrepant opinions leading to change in clinical management. Secondary outcome was report addendum rate compared with an existing peer learning program using Fisher's exact test.

RESULTS

Of 114 discrepant opinion alerts among 1,888,147 reports generated during the study period (0.006%), 58 alerts were categorized as major (50.9%), 41 as moderate (36.0%), and 15 as minor discrepancies (13.1%). Clinical management change occurred in 64 of 114 cases (56.1%). Report addendum rate for discrepant opinion alerts was 4-fold higher than for peer learning alerts at our institution (66 of 315 = 21% versus 432 of 8,273 =5.2%; P < .0001).

DISCUSSION

Although discrepant intra-institutional radiologist second opinions were rare, they frequently led to changes in clinical management. Capturing these discrepancies by encouraging alert use may help optimize patient care and document what was communicated to the referring or consulting care team by consulting radiologists.

Abdominal peer learning: advantages and lessons learned

In 2017, our tertiary hospital-based imaging practice transitioned from score-based peer review to the peer learning methodology for learning and improvement. In our subspecialized practice, peer learning submissions are reviewed by domain experts, who then provide feedback to individual radiologists, curate cases for group learning sessions, and develop associated improvement initiatives. In this paper, we share lessons learned from our abdominal imaging peer learning submissions with the assumption that trends in our practice likely mimic others', and hope that other practices can avoid future errors and elevate the level of the quality of their own performance. Adoption of a nonjudgmental and efficient method to share peer "learning opportunities" and "great calls" has increased participation in this activity and increased transparency into our practice, thus allowing for visualization of trends in performance. Peer learning allows us to bring our own individual knowledge and practices together for group review in a collegial and safe environment. We learn from each other and decide how to improve together.

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.

Assessment of a Large-Scale Peer Learning Program's Value by Manual Review of Case Submissions

OBJECTIVE

Prior studies used submission numbers or report addendum rates to measure peer learning programs' (PLP) impact. We assessed the educational value of a PLP by manually reviewing cases submitted to identify factors correlating with meaningful learning opportunities (MLOs).

METHODS

This institutional review board-exempted, retrospective study was performed in a large academic radiology department generating >800,000 reports annually. A PLP facilitating radiologist-to-radiologist feedback was implemented May 1, 2017, with subsequent pay-for-performance initiatives encouraging increasing submissions, >18,000 by 2019. Two radiologists blinded to submitter and receiver identity categorized 336 randomly selected submissions as a MLO, not meaningful, or equivocal, resolving disagreements in consensus review. Primary outcome was proportion of MLOs. Secondary outcomes included percent engagement by subspecialty clinical division and comparing MLO and report addendum rates via Fisher's exact tests. We assessed association between peer learning category, pay-for-performance interventions, and subspecialty division with MLOs using logistic regression.

RESULTS

Of 336 PLP submissions, 65.2% (219 of 336) were categorized as meaningful, 27.4% (92 of 336) not meaningful, and 7.4% (25 of 336) equivocal, with substantial reviewer agreement (86.0% [289 of 336], κ = 0.71, 95% confidence interval 0.64-0.78). MLO rate (65.2% [219 of 336]) was five times higher than addendum rate (12.9% [43 of 333]) for the cohort. MLO proportion (adjusted odds ratios 0.05-1.09) and percent engagement (0.5%-3.6%) varied between subspecialty divisions, some submitting significantly fewer MLOs (P < .01). MLO proportion did not vary between peer learning categories.

CONCLUSION

Educational value of a large-scale PLP, estimated through manual review of case submissions, is likely a more accurate measure of program impact. Incentives to enhance PLP use did not diminish the program's educational value.

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.

Peer learning in breast imaging

With the increasing focus on quality and safety in medicine, radiology practices are increasingly transitioning from traditional score-based peer review to peer learning. Participation in a peer learning program can increase learning, practice improvement, and cultivation of interpersonal relationships in a non-punitive environment. As breast imaging errors are the most cited in medical malpractice cases, learning and attention to and reduction of these errors in breast imaging are especially important. We describe the strengths of a peer learning program, implementation process in a breast imaging program, challenges to overcome, and strategies to support success.

CAR Peer Learning Guide

Peer learning is a quality initiative used to identify potential areas of practice improvement, both on a patient level and on a systemic level. Opportunities for peer learning include review of prior imaging studies, evaluation of cases from multidisciplinary case conferences, and review of radiology trainees' call cases. Peer learning is non-punitive and focuses on promoting life-long learning. It seeks to identify and disseminate learning opportunities and areas for systems improvement compared to traditional peer review. Learning opportunities arise from peer learning through both individual communication of cases reviewed for routine work, as well as through anonymous presentation of aggregate cases in an educational format. In conjunction with other tools such as root cause analysis, peer learning can be used to guide future practice improvement opportunities. This guide provides definitions of terms and a synthetic evidence review regarding peer review and peer learning, as well as medicolegal and jurisdictional considerations. Important aspects of what makes an effective peer learning program and best practices for implementing such a program are presented. The guide is intended to be a living document that will be updated regularly as new data emerges and peer learning continues to evolve in radiology practices.

Implementation of peer learning conferences throughout a multi-site abdominal radiology practice

PURPOSE

To initiate a peer learning conference for our abdominal radiology division across multiple geographically separated sites and different time zones, and to determine radiologist preference for peer learning versus traditional score-based peer review.

METHODS

We implemented a monthly peer learning videoconference for our abdominal radiology division. Surveys regarding radiologist opinion regarding traditional peer review and the new peer learning conferences were conducted before and after 6 months of conferences.

RESULTS

Peer learning conferences were well attended across our multiple sites, with an average of 43 participants per conference. Radiologist opinion regarding peer review was poor, with survey radiologists responding positively to only 1 out of 12 process questions. Opinion regarding peer learning was extremely favorable, with radiologists responding positively to 12 out of the same 12 process questions. After 6 months of peer learning conferences, 87.9% of surveyed radiologists wished to continue them in some fashion, and no one preferred to return to score-based peer review alone.

CONCLUSION

We successfully implemented a peer learning conference for our abdominal radiology division spread out over multiple geographic sites. Our radiologists strongly preferred peer learning conferences over our traditional peer review system for quality control.

Use of a PACS Embedded System for Communicating Radiologist to Technologist Learning Opportunities and Patient Callbacks

OBJECTIVE

This study aimed to determine effect of modality, care setting, and radiology subspecialty on frequency of diagnostic image quality issues identified by radiologists during image interpretation.

METHODS

This Institutional Review Board-exempt retrospective study was performed 10/1/18-6/30/20 at an academic radiology practice performing 700,000+ examinations annually. A closed-loop communication tool integrated in PACS workflow enabled radiologists to alert technologists to image quality issues. Radiologists categorized communications as requiring patient callback, or as technologist learning opportunities if image quality was adequate to generate a diagnostic report. Fisher's exact test assessed impact of imaging modality, radiology subspecialty, and care setting on radiologist-identified image quality issues.

RESULTS

976,915 imaging examinations were performed during the study period. Radiologists generated 1,935 technologist learning opportunities (0.20%) and 208 callbacks (0.02%). Learning opportunity rates were highest for MRI (0.60%) when compared to CT (0.26%) and radiography (0.08%) (p<0.0001). The same was true for patient callbacks (MRI 0.13%, CT 0.02%, radiography 0.0006%; p<0.0001). Outpatient examinations generated more learning opportunities (1479/637,092; 0.23%) vs. inpatient (305/200,206; 0.15%) and Emergency Department (151/139,617; 0.11%) (p<0.0001). Abdominal subspecialists were most likely to generate learning opportunities when compared to other subspecialists and cardiovascular imagers were most likely to call a patient back.

CONCLUSIONS

Image quality issues identified by radiologists during the interpretation process were rare and 10 times more commonly categorized as learning opportunities not interfering with a clinically adequate report than as requiring patient callback. Further work is necessary to determine if creating learning opportunities leads to fewer patients requiring repeat examinations.

Perspective: in pursuit of a learning culture

Transitioning from peer review to peer learning is an important step forward in developing a learning culture. Additional measures are going to be required to meet this goal. Ideas toward establishing a learning culture are detailed in this perspective.

Peer Learning and Operationalizing During COVID-19 Pandemic and Beyond

The main objective of the article is to describe the changes in managing the peer learning system in the Department of Abdominal Imaging at our institution during the pandemic and its restrictions. The pandemic poses diverse challenges to academic institutions across the country including radiology education and peer learning. The health sector in some areas of the country has been stretched by the number of coronavirus disease 2019 (COVID-19) patients. In March 2020, our institution cancelled all in-person conferences as per guidelines from the Center of Disease Control and Prevention to mitigate the spread of COVID-19 and the conferences were shifted to virtual platforms. Our recent peer learning approach allowed us to practice appropriate social distancing while following the institutional and national guidelines with minimal disruption. Other institutions that are facing similar challenges can adopt or modify our framework of a successful and efficient virtual peer learning process.

Radiologist Well-Being and Professional Fulfillment in the COVID-19 Era: Fostering Posttraumatic Growth

The acute consequences of the COVID-19 pandemic have impacted wellness strategies aimed at mitigating the pre-existing epidemic of burnout in radiology. Specifically, safety measures including social distancing requirements, effective communications, supporting remote and distributed work teams, and newly exposed employment and treatment inequities have challenged many major efforts at fostering professional fulfillment. To get our wellness efforts back on track and to achieve a new and perhaps even a better "normal" will require refocusing and reconsidering ways to foster and build a culture of wellness, implementing practices that improve work efficiencies, and supporting personal health, wellness behaviors, and resilience. Optimizing meaning in work is also critical for well-being and professional fulfillment. In addition to these earlier approaches, organizations and leaders will need to reprioritize efforts to build high-functioning cohesive and connected teams; to train, implement, and manage peer-support practices; and to support posttraumatic growth. This growth represents the positive psychological changes that can occur after highly challenging life circumstances and, when successful, allows individuals to achieve a higher level of functioning by addressing and learning from the precipitating event. Our practices can support this growth through education, emotional regulation, and disclosure, by developing a narrative that reimagines a hoped-for better future and by finding meaning through services that benefit others.

Step by Step: A Structured Approach for Proposing, Developing and Implementing a Radiology Peer Learning Program

Similar to the experiences of other radiology practices, our radiology staff members felt that scored peer review identified few errors/learning opportunities while undermining team collegiality. They desired a more effective way to promote team collegiality and foster lifelong learning. We describe the steps our department took to transition from a peer review system to a peer learning program.