Does simulation training result in improved on-call outcomes among newly appointed radiology registrars?

AIM

To quantify the impact of a marked increase in radiology trainee numbers and the compensatory introduction of formal simulation on-call training by investigating the discrepancy rates among on-call radiologists in training before and after the introduction of structured simulation training.

MATERIALS AND METHODS

The first 100 cases reported by a cohort of Specialty Trainee Year 2 doctors (ST2), having commenced on-call reporting, were analysed. This included registrars working in two major tertiary centres. Two groups of registrars were compared directly: those who undertook the simulation training and those who did not. Discrepancies were divided by severity into minor, moderate, and major categories. The criteria for each category were based on previously published literature.

RESULTS

Twelve registrars from 2017 were compared with 12 from previous years (two in 2013, four in 2014, and six in 2015); 2,320 cases were analysed. There was a statistically significant reduction in the total number of discrepancies (p=0.01) made by registrars who underwent simulation training. A similar improvement was observed in the number of major discrepancies; however, this was not statistically significant.

CONCLUSION

The present study shows that simulation training successfully increases competency in on-call work. Despite doubling the number of doctors in training, discrepancy rates did not worsen and in fact improved.

After-hours radiology reporting in an Australian tertiary hospital: Factors influencing the rate of discrepancy for computed tomography reporting

INTRODUCTION

Demand for after-hours radiology services across Australia has been rapidly increasing for many years. Public hospital radiology departments are generally staffed by trainees after hours, often 1-2 doctors. This study reviewed 1 year of after-hours data at a tertiary hospital in Sydney, to determine overall discrepancy rates and factors which influenced the rate of discrepancy after hours. Overall radiology and after-hours case volumes are increasing, and the goal was to ensure that our department practices are within safe limits at current staffing levels.

METHODS

After-hours computed tomography scan reports issued by registrars were reviewed over 1 year between 01 January 2019 and 01 January 2020. Data recorded included overall case numbers on each shift, discrepancy rates and rates of clinically significant discrepancy. Caseload was measured by equivalent ascribed reporting time as described by Pitman et al. (2018).

RESULTS

There were 10,886 cases reported after hours during the study period and 1,412 discrepancies (13% cases). Of these, 300 (3.7%) were clinically significant. Factors that increased the rate of significant discrepancy included shifts with caseloads greater than 3 h of equivalent consultant reporting time per 8-h shift and the radiology trainee's level of training. The frequency of discrepancy for trauma cases was similar to non-trauma after adjusting for study type; however, the frequency of significant discrepancy was higher.

CONCLUSION

In all instances, the rates of discrepancy and clinically significant discrepancy remained well within ranges previously described.

Resident-attending discrepancy rates for two consecutive versus nonconsecutive weeks of overnight shifts

PURPOSE

Recent Accreditation Council for Graduate Medical Education policy changes no longer limit the number of consecutive night shifts allowed for trainees. Few studies have examined radiology resident overnight performance over time. This study aimed to compare significant resident-attending discrepancy rates for residents working 2 nonconsecutive versus consecutive weeks of overnight shifts. The authors hypothesized significantly increased week-two discrepancies in the consecutive group.

METHODS

For 2020, a retrospective analysis of significant overnight resident-attending discrepancy rates over a 24-week period using database searches was performed for residents self-selecting 2 nonconsecutive versus consecutive weeks. The nonconsecutive group typically had a 7-day mix of days off and day shifts between their night shift weeks. Paired and unpaired t tests were performed with p < 0.05 considered significant.

RESULTS

For the 24 sets of 2 weeks covered by two residents at a time, eight were nonconsecutive and 16 were consecutive. The nonconsecutive group had 75.0% R4 coverage compared to 37.5% for the consecutive group. There were no significant study volume differences between the groups. A total of 27,906 studies (35.3% cross-sectional [CT and MR], 54.9% radiograph plus fluoroscopy, 9.8% US) were performed with 223 discrepancies (0.80%). Overall discrepancies for the nonconsecutive versus consecutive groups were 39/4505 (0.87%) versus 59/9462 (0.62%; p = 0.32) for week one and 46/4732 (1.0%) versus 79/9207 (0.86%; p = 0.60) for week two with no significant differences between the groups by modality.

CONCLUSION

Residents self-selecting 2 consecutive weeks of overnight shifts do not have increased resident-attending discrepancy rates compared to 2 nonconsecutive weeks.

Accuracy of after-hours trauma cervical spine CT reporting by radiology trainees: Experiences from two Australian teaching hospitals

INTRODUCTION

Like many teaching hospitals in Australia, after-hours computed tomography (CT) reporting at our institution is undertaken by the on-call radiology registrar. The accuracy of these reports is important as management is often initiated based on the interim findings, prior to review by the consultant radiologist. A common exception to this approach is cervical CT (CCT), as many hospital protocols recommend patients to remain in spinal precautions until the report is finalised by a consultant, although there are very few studies to support this practice.

METHODS

The interim registrar reports for all CCTs performed after-hours over a 12-month period were retrospectively reviewed. The final consultant report was used as the gold standard to establish accuracy of the registrar report. The primary outcome was discrepancy between the provisional and final reports. Any discrepancy was classified as either an 'overcall' or 'miss'. Discrepancies were graded by the RADPEER scoring system.

RESULTS

A total of 1084 after-hours CCT studies were reviewed. The number of cases positive for injury was 37 (3.4%). The total number of discrepancies was 14 (discrepancy rate 1.3%), including 4 overcalls (0.3%) and 10 misses (0.9%). The discrepancy rates for junior and senior registrars were 1.7% and 0.7% respectively. Only 5 misses (0.5%) were considered clinically significant.

CONCLUSION

Registrars reporting after-hours CCT have low rates of discrepancy with very few clinically significant misses. However, the reduced registrar sensitivity for detection of cervical injury highlights the ongoing importance of consultant review in the process of cervical spine clearance pathways.

The Cheshire & Merseyside Collaborative trainee-led on-call service: a review of safety and efficiency

AIM

To assess safety and efficiency of the Cheshire & Merseyside Collaborative, the largest trainee led on-call service in the UK, based on discrepancy rates and time taken to issue reports.

MATERIALS & METHODS

All studies reported by the collaborative in a 4-week period were evaluated for discrepancy and the time taken to issue a report. These figures were compared against the Royal College of Radiologists (RCR) guidelines and a recent national audit of discrepancy rates. The time taken to report was measured against the National Institute of Health and Clinical Excellence (NICE) and Trauma Audit Research Network (TARN) guidelines.

RESULTS

The overall discrepancy rates for the collaborative were 2.5% for minor discrepancies and 2% for major discrepancies, which is within the RCR standard. The median time taken to issue a report was 30 min, which is within the NICE and TARN 1-h targets.

CONCLUSIONS

The Cheshire & Merseyside Collaborative can be deemed a safe and efficient way of delivering an out-of-hours radiology service.