- Email: [email protected]
Radiology-Pathology Conference
ARTICLE IN PRESS
Radiology Resident Education
Radiology-Pathology Conference: Reviving the Art of Oral Case Presentation in Residency Susan Sotardi, MD1, Meir H. Scheinfeld, MD, PhD, Judah Burns, MD, Mordecai Koenigsberg, MD, Jose G. Mantilla, MD, Shlomit Goldberg-Stein, MD Rationale and Objectives: To improve resident oral case communication and preparatory skills by providing residents an opportunity to prepare for and conduct a new interdisciplinary Radiology-Pathology (Rad-Path) conference series. Materials and Methods: To assess whether conference goals were being achieved, we surveyed trainees and attendings in the radiology and pathology departments. Percentages were examined for each variable. Mann-Whitney U test for ordinal variable significance was applied to determine statistical significance between radiology trainee and attending survey responses. Results: Most surveyed radiology trainees (57.1%) strongly agreed or agreed with: “I wish I felt more comfortable with oral presentations.” Sixty-five percent of radiology attendings (34 of 52) either agreed or strongly agreed that the residents should be more comfortable with oral case presentations. Of resident Rad-Path conference presenters, 69% (9 of 13) either agreed or strongly agreed that the conference improved their confidence and/or ability to present case information orally. Of responders who attended at least one Rad-Path conference in person, 83% of residents (19/23) and 61% (17/28) of attendings agreed or strongly agreed that the conference improved their ability to formulate a differential diagnosis. Using the Mann-Whitney U test, no significant difference was found between radiology trainees and attendings’ responses. Conclusions: Our Rad-Path correlation conference was specifically designed and structured to provide residents with focused experience in formal oral case preparation and presentation. We consider our conference a success, with 69% of resident presenters reporting that the Rad-Path conference improved their confidence and/or ability to present case information orally. Key Words: Resident education; value-added; radiology-pathology conference. © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
INTRODUCTION
C
ommunication skills, and specifically the art of case presentation, have been a focus of resident education throughout the history of the field of radiology. Indeed, the oral board examination format was previously a test of those skills. With the recent shift to an exclusively “written” board examination format, resident teaching and preparatory activities, particularly those targeting senior residents, have taken a different form both at our institution and anecdotally, nationwide. At a time when our value as radiologists hinges not on the number of reports we produce but rather on our ability to improve patient outcomes by communicating more effectively with patients and referring
clinicians, there is an increasing need for focused educational activities to strengthen these skills in our residents. In the Fall of 2014, we initiated a Radiology-Pathology (Rad-Path) correlation conference series specifically designed to provide residents an opportunity to independently prepare for and conduct an interdisciplinary conference. The major goal was to improve resident case communication skills and case preparatory skills. Expected secondary goals were to expand our residents’ ability to formulate differential diagnoses and to promote their appreciation of radiology and pathology as interrelated and often codependent disciplines. MATERIALS AND METHODS
Acad Radiol 2017; ■:■■–■■
Conference Organization
From the Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467 (S.S., J.B., M.K., M.H.S., S.G.-S.); Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (J.G.M.). Received October 13, 2016; revised November 24, 2016; accepted December 2, 2016. 1Present address: Department of Neuroradiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. Address correspondence to: S.S. e-mail: [email protected]
The conference setting consists of subspecialty academic radiology and pathology departments at a large tertiary-care medical center. The Department of Radiology consists of 82 faculty members, 36 residents, and 13 fellows, and the Department of Pathology consists of 56 attendings, 17 residents, and 8 fellows. We aimed to carefully balance resident autonomy with direct faculty oversight so that the resident would be able to develop these skills in an independent, yet
© 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.acra.2016.12.019
1
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SOTARDI ET AL
supervised manner. The conference organization reflects the central goal of improving resident case preparation and communication skills. There are six dedicated Rad-Path conference subspecialty radiology faculty mentors and six subspecialty pathology faculty mentors. One faculty member also serves as the overall conference chairperson. Radiology residents actively participate in the conference twice during their residency, during the PGY3 and PGY5 years. The conference is bimonthly and corresponds to the following six topics: Cardiothoracic, Abdominal, Musculoskeletal, Pediatric, Neuroradiology, and Breast. Conference Preparation
For each conference, four separate resident roles are designated (organizing, presenting, literature review, and pathology). The descriptions of resident roles and timing of responsibilities are detailed in Table 1. The organizing resident is responsible for selecting three suitable, pathologically confirmed cases that may have a rare diagnosis, unusual clinical or imaging presentation, or classic features of a common or uncommon entity. Case images may include radiographs, mammograms, computed tomography, ultrasound, and/or magnetic resonance studies. Images to be presented are chosen and placed into PowerPoint (Microsoft, Redmond, WA) slides with relevant clinical history by the organizing resident. The designated faculty mentor provides feedback and oversight in case se-
lection and preparation. The pathology resident prepares the pathology case images, differential diagnosis, and discussion with the oversight of the designated subspecialty pathology faculty mentor. The literature review resident prepares a focused 6 to 8-minute academic discussion of the case topic. The radiology faculty mentor provides feedback at multiple stages in the preparation process to achieve a focused and polished final presentation. One week prior to the conference, the presenting resident, blinded to the radiology and pathology reports and diagnoses, receives only the PowerPoint presentation with the three cases. During that week, he or she prepares the oral case discussion including a weighted differential diagnosis for each of the three cases. The conference chair meets with the presenting resident for practice presentations to allow for feedback on presentation skills, fine-tuning of the presentation, and ultimately to increase resident confidence with the oral presentation. The conference chair takes great care not to “unblind” the presenting resident to the final diagnosis or provide any additional content to the prepared case presentation. The Conference
Conference attendees typically include radiology and pathology attendings including departmental leadership, radiology and pathology trainees (residents and fellows), and rotating medical students. On conference day, the organizing
TABLE 1. Resident Rad-Path Conference Responsibilities Organizing Radiology Resident (PGY3) One month prior to conference
One week prior to conference
Conference day
2
Literature Review Radiology Resident (PGY3 or 5)
Selects cases and prepares PowerPoint presentation Meets with subspecialty radiology faculty mentor NA
NA
Serves as conference moderator; mediate discussion
Presents scholarly discussion for each case
Meets with faculty mentor to finalize and practice presentation
Presenting Radiology Resident (PGY 5)
Pathology Resident Receives case information from the organizing resident Prepares pathology case slides, differential diagnosis, and discussion Meets with the designated subspecialty pathology faculty mentor Meets with faculty mentor to finalize and practice presentation
Presents pathology slides, differential diagnosis, discussion, and the final pathology diagnosis
NA
Blinded to the case diagnosis: receives anonymized PowerPoint from the organizing resident Prepares case discussion and differential diagnosis Meets with conference chair to finalize and practice presentation Provides a focused, clear discussion of each case with a weighted differential diagnosis, including most common or likely diagnosis, and “zebras” Receives questions and feedback from audience
Academic Radiology, Vol ■, No ■■, ■■ 2017
resident serves as the conference moderator. The presenting resident provides a focused, clear discussion of each case with a weighted differential diagnosis. The pathology resident then presents images of the corresponding histologic pathology slides, differential diagnosis, discussion, and the final pathology diagnosis. Finally, the literature review resident presents the prepared academic discussion. These roles are repeated for each of the three cases per conference. After each presentation, the organizing resident solicits feedback from the audience. These important moments give the residents an opportunity to receive both questions and direct feedback on their presentations from the audience, and demonstrate mastery of the material they have presented.
ORAL CASE PRESENTATION REVIVAL IN RESIDENCY
orally, compared to fourth-year residents trained under the old ABR examination format (Table 3). Participants
Thirteen radiology residents responding to the survey had directly participated in the Rad-Path conferences in one of the four possible roles delineated earlier. Eighty-five percent (11 of 13) either agreed or strongly agreed that residents were given significant autonomy and that the conference was “resident-run.” Additionally, 69% (9 of 13) either agreed or strongly agreed that the Rad-Path conference had improved their confidence and/or ability to present case information orally.
Assessment Attendees
To assess whether the goals of the Rad-Path conference were being achieved, we created an anonymous online survey for trainees and attendings in both the radiology and pathology departments. The survey questions are summarized in Table 2. Questions were presented as multiple-choice answers. A 5-point Likert scale (strongly agree, agree, neither, disagree, and strongly disagree) comprised the majority of questions. Percentages were examined for each variable. For several survey questions, we examined whether there was a statistically significant difference between radiology trainee and attending groups by using the Mann-Whitney U test for ordinal variable significance. Statistical analysis was performed using STATA 14.0 (StataCorp, College Station, TX). RESULTS Respondents
Our survey respondents consisted of 87 radiologists and 32 pathologists. Among radiologists, 60% (52 of 87) were attendings and 40% (35 of 87) were trainees (9 PGY2, 6 PGY3, 7 PGY4, 6 PGY5, and 7 fellows). Among pathologists, 47% (15 of 32) were attendings and 53% (17 of 32) were trainees (5 PGY1, 4 PGY2, 6 PGY3, 2 PGY4). Context
The majority (20 of 35, 57.1%) of radiology trainees either agreed or strongly agreed with the statement: “I wish I felt more comfortable with oral presentations” (Table 2). The majority of radiology attendings (34 of 52, 65%) either agreed or strongly agreed that the residents should be more comfortable with oral case presentations. Radiology attendings who responded “yes” to having mentored residents in preparation for both the old and new American Board of Radiology (ABR) board examinations were asked to compare residents trained under the two formats. Twenty-eight of 38 (74%) responding radiology attendings believed that fourth-year residents examined with the new ABR board examinations were either less prepared or significantly less prepared to present cases
Fifty-nine percent (51/87) of radiologists responding to the survey had attended at least one Rad-Path conference in person (excluding remote attendees through teleconference at offsite locations). Forty-one percent (36/87) of the respondents had not attended any Rad-Path conference. Of those who did not attend, 9 of 36 were first-year residents and 3 of 36 were fellows who completed the survey prior to the start of the annual Rad-Path conference. The remainder included 24 attendings with conflicting clinical responsibilities. We asked those respondents who had attended at least one Rad-Path conference whether the conference had improved their ability to formulate a differential diagnosis and/or improved their appreciation for the fields of radiology and pathology. Of the radiology trainees in this group, 83% (19/23) agreed or strongly agreed that the conference had improved their ability to formulate a differential diagnosis, 83% (19/23) agreed or strongly agreed that the conference had improved their appreciation for radiology, and 83% (19/23) agreed or strongly agreed that the conference had improved their appreciation for pathology. Of the radiology attendings in this group, 61% (17/28) agreed or strongly agreed that the conference had improved their ability to formulate a differential diagnosis, 68% (19/28) agreed or strongly agreed that the conference had improved their appreciation for radiology, and 71% (20/28) agreed or strongly agreed that the conference had improved their appreciation for pathology. Radiology attendees (39.2%, 20 of 51), including attendings and trainees, felt that attendance at the conference increased their confidence or ability to speak with clinicians. Of the attendees who were radiology trainees, 34.8% (8/23) agreed or strongly agreed that attending the conference increased their confidence or ability to speak with clinicians. Using the Mann-Whitney U test, no significant difference was found between radiology trainees and attendings. DISCUSSION With the transition of the radiology board examination from oral to written format, case communication skills are practiced and tested less than in the past. This may have important 3
SOTARDI ET AL
Academic Radiology, Vol ■, No ■■, ■■ 2017
TABLE 2. Radiology Attendings and Trainees’ Experience with Rad-Path Conference Questions Both attendings and trainees Have you attended the Rad-Path conference? Yes No What is your level of training? PGY2 PGY3 PGY4 PGY5 Fellow Attending Rad-Path conference increased my appreciation for the field of radiology. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path conference increased my appreciation for the field of pathology. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path conference helped me learn about formulating a differential diagnosis. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path conference increased my confidence or ability to speak with clinicians. Strongly agree Agree Neither Disagree Strongly disagree Trainees only Rad-Path is a “resident ran” conference, meaning that I had a significant amount of autonomy in devising the presentation. Strongly agree Agree Neither Disagree Strongly disagree Participating in Rad-Path conference increased my confidence and/or ability to present case information orally. Strongly agree Agree Neither Disagree Strongly disagree I wish I were more comfortable giving oral presentations. Strongly agree Agree Neither Disagree Strongly disagree Attendings only The residents ought to be more comfortable giving oral presentations. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path, Radiology-Pathology.
4
Number
Percent
51 36
59 41
9 6 7 6 7 52
10.3 6.9 8.0 6.9 8.0 59.8
16 22 8 3 2
31.4 43.1 15.7 5.9 3.9
11 28 8 3 1
21.6 54.9 15.7 5.9 2.0
8 28 11 4 0
15.7 54.9 21.6 7.8 0
5 15 22 5 4
9.8 29.4 43.1 9.8 7.8
7 4 2 0 0
53.8 30.8 15.4 0 0
6 3 3 1 0
46.1 23.1 23.1 7.7 0
5 15 10 5 0
14.3 42.9 28.6 14.3 0
20 14 16 2 0
38.5 26.9 30.8 3.8 0
Academic Radiology, Vol ■, No ■■, ■■ 2017
ORAL CASE PRESENTATION REVIVAL IN RESIDENCY
TABLE 3. Radiology Attendings and Trainees’ Perceived Competence by Board Format How Has the New Radiology Board Examination Format (ABR Core Examination) Altered the Ability of 4th Year Residents to Take Cases? Significantly LESS capable than oral board preparation Slightly LESS capable than oral board preparation About the same as oral board preparation Slightly MORE capable than oral board preparation Significantly MORE capable than oral board preparation
negative implications practically in the current environment, where radiologists are being encouraged more than ever to “come out of the dark” and engage both referrers and patients. Formal case preparation and discussion has the potential to help in achieving that goal. Case preparation requires the deliberate extraction, arrangement, and presentation of patient clinical and imaging information. Focused faculty mentoring teaches residents the skills to more effectively communicate his or her thought process in an ordered and focused manner. The opportunity to practice and hone these skills, while receiving custom-tailored feedback from faculty mentors, is invaluable for residents, and may be useful to them throughout their professional careers. Surveyed radiology trainees at all levels perceived a need for improvement in resident oral case presentation skills (57%), and surveyed attendings (65%) agreed with this need. Importantly, 69% of residents who presented at a single RadPath conference felt that the experience significantly improved their confidence and/or ability to present case information orally. In contrast to the trainees who directly participated in the presentation of cases, only 34.8% (8/23) of radiology trainees who merely attended the conference either agreed or strongly agreed that the conference increased their confidence or ability to speak with clinicians. This suggests that the act of presenting at the conference, as opposed to attendance alone, yields added benefit to the education of trainees. Because residents stand to benefit from the skills learned during Rad-Path conferences, we believe that these programs should be expanded across residency programs, so that all radiology residents are given opportunities to hone these important skills. Our findings confirm prior studies on the benefits of resident-driven educational conferences to radiology pedagogy. Several studies have demonstrated that residentprepared lectures were an effective means of teaching residents (1–4). Donovan et al. found that the majority of radiology residency program directors agreed that it is important for residents to teach (98%) and that these teaching experiences helped residents become better radiologists (85%) (3). Jafri et al. assessed the impact of a formal Rad-Path correlation conference held by medical students mentored by radiology faculty (5).
Number
Percent
11 17 10 0 0
28.9 44.7 26.3 0 0
In their study, 117 students (83%) felt that the session improved their understanding of the longitudinal care of patients, and 84% of students preferred the student-facilitated format to a resident-ran conference. Our survey data indicate that a resident-led Rad-Path conference addresses important aspects of resident training, increases interdisciplinary appreciation, and facilitates the exchange of knowledge between the radiology and pathology communities. By training residents in the art of oral presentation, we invest in the future of the field of radiology and ensure that it remains integrated and relevant both to the wider healthcare community and to the care of patients. ACKNOWLEDGMENTS The authors would like to acknowledge the dedicated work of our residents and our Radiology-Pathology conference faculty, without whom this would not be possible. Our Radiology faculty mentors (past and present) include: Dr. Beverly Thornhill, Dr. Shari Friedman, Dr. Richard Zampolin, Dr. Jessica Kurian, Dr. Sarah Oh, Dr. Mariya Kobi, Dr. Linda Broyde-Haramati, Dr. Anna Shmukler, and Dr. Beatriu Reig. Our Pathology faculty mentors include: Dr. Esperanza Villanueva-Siles, Dr. Karen Weidenheim, Dr. Michelle Ewart, Dr. Kathryn Tanaka, Dr. Qiang Liu, Dr. Perry Cohen, Dr. ChangCheng Zhu, and Dr. Susan Fineberg. REFERENCES 1. Collins J, Miller SS, Albanese MA. Resident learning and knowledge retention from resident-prepared chest radiology conferences. Acad Radiol 1997; 4:732–735. 2. Linaker KL. Pedagogical approaches to diagnostic imaging education: a narrative review of the literature. J Chiropr Humanit 2015; 22:9–16. 3. Donovan A. Radiology residents as teachers: current status of teaching skills training in United States residency programs. Acad Radiol 2010; 17:928–933. 4. Mainiero MB, Collins J, Primack SL. Effectiveness of resident-prepared conferences in teaching imaging utilization guidelines to radiology residents. Acad Radiol 1999; 6:748–751. 5. Jafri NF, Nadgir R, Slanetz PJ. Student-facilitated radiology-pathology correlation conferences: an experiential educational tool to teach multidisciplinary patient care. J Am Coll Radiol 2010; 7:512–516.
5
Radiology Resident Education
Radiology-Pathology Conference: Reviving the Art of Oral Case Presentation in Residency Susan Sotardi, MD1, Meir H. Scheinfeld, MD, PhD, Judah Burns, MD, Mordecai Koenigsberg, MD, Jose G. Mantilla, MD, Shlomit Goldberg-Stein, MD Rationale and Objectives: To improve resident oral case communication and preparatory skills by providing residents an opportunity to prepare for and conduct a new interdisciplinary Radiology-Pathology (Rad-Path) conference series. Materials and Methods: To assess whether conference goals were being achieved, we surveyed trainees and attendings in the radiology and pathology departments. Percentages were examined for each variable. Mann-Whitney U test for ordinal variable significance was applied to determine statistical significance between radiology trainee and attending survey responses. Results: Most surveyed radiology trainees (57.1%) strongly agreed or agreed with: “I wish I felt more comfortable with oral presentations.” Sixty-five percent of radiology attendings (34 of 52) either agreed or strongly agreed that the residents should be more comfortable with oral case presentations. Of resident Rad-Path conference presenters, 69% (9 of 13) either agreed or strongly agreed that the conference improved their confidence and/or ability to present case information orally. Of responders who attended at least one Rad-Path conference in person, 83% of residents (19/23) and 61% (17/28) of attendings agreed or strongly agreed that the conference improved their ability to formulate a differential diagnosis. Using the Mann-Whitney U test, no significant difference was found between radiology trainees and attendings’ responses. Conclusions: Our Rad-Path correlation conference was specifically designed and structured to provide residents with focused experience in formal oral case preparation and presentation. We consider our conference a success, with 69% of resident presenters reporting that the Rad-Path conference improved their confidence and/or ability to present case information orally. Key Words: Resident education; value-added; radiology-pathology conference. © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
INTRODUCTION
C
ommunication skills, and specifically the art of case presentation, have been a focus of resident education throughout the history of the field of radiology. Indeed, the oral board examination format was previously a test of those skills. With the recent shift to an exclusively “written” board examination format, resident teaching and preparatory activities, particularly those targeting senior residents, have taken a different form both at our institution and anecdotally, nationwide. At a time when our value as radiologists hinges not on the number of reports we produce but rather on our ability to improve patient outcomes by communicating more effectively with patients and referring
clinicians, there is an increasing need for focused educational activities to strengthen these skills in our residents. In the Fall of 2014, we initiated a Radiology-Pathology (Rad-Path) correlation conference series specifically designed to provide residents an opportunity to independently prepare for and conduct an interdisciplinary conference. The major goal was to improve resident case communication skills and case preparatory skills. Expected secondary goals were to expand our residents’ ability to formulate differential diagnoses and to promote their appreciation of radiology and pathology as interrelated and often codependent disciplines. MATERIALS AND METHODS
Acad Radiol 2017; ■:■■–■■
Conference Organization
From the Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467 (S.S., J.B., M.K., M.H.S., S.G.-S.); Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (J.G.M.). Received October 13, 2016; revised November 24, 2016; accepted December 2, 2016. 1Present address: Department of Neuroradiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. Address correspondence to: S.S. e-mail: [email protected]
The conference setting consists of subspecialty academic radiology and pathology departments at a large tertiary-care medical center. The Department of Radiology consists of 82 faculty members, 36 residents, and 13 fellows, and the Department of Pathology consists of 56 attendings, 17 residents, and 8 fellows. We aimed to carefully balance resident autonomy with direct faculty oversight so that the resident would be able to develop these skills in an independent, yet
© 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.acra.2016.12.019
1
Academic Radiology, Vol ■, No ■■, ■■ 2017
SOTARDI ET AL
supervised manner. The conference organization reflects the central goal of improving resident case preparation and communication skills. There are six dedicated Rad-Path conference subspecialty radiology faculty mentors and six subspecialty pathology faculty mentors. One faculty member also serves as the overall conference chairperson. Radiology residents actively participate in the conference twice during their residency, during the PGY3 and PGY5 years. The conference is bimonthly and corresponds to the following six topics: Cardiothoracic, Abdominal, Musculoskeletal, Pediatric, Neuroradiology, and Breast. Conference Preparation
For each conference, four separate resident roles are designated (organizing, presenting, literature review, and pathology). The descriptions of resident roles and timing of responsibilities are detailed in Table 1. The organizing resident is responsible for selecting three suitable, pathologically confirmed cases that may have a rare diagnosis, unusual clinical or imaging presentation, or classic features of a common or uncommon entity. Case images may include radiographs, mammograms, computed tomography, ultrasound, and/or magnetic resonance studies. Images to be presented are chosen and placed into PowerPoint (Microsoft, Redmond, WA) slides with relevant clinical history by the organizing resident. The designated faculty mentor provides feedback and oversight in case se-
lection and preparation. The pathology resident prepares the pathology case images, differential diagnosis, and discussion with the oversight of the designated subspecialty pathology faculty mentor. The literature review resident prepares a focused 6 to 8-minute academic discussion of the case topic. The radiology faculty mentor provides feedback at multiple stages in the preparation process to achieve a focused and polished final presentation. One week prior to the conference, the presenting resident, blinded to the radiology and pathology reports and diagnoses, receives only the PowerPoint presentation with the three cases. During that week, he or she prepares the oral case discussion including a weighted differential diagnosis for each of the three cases. The conference chair meets with the presenting resident for practice presentations to allow for feedback on presentation skills, fine-tuning of the presentation, and ultimately to increase resident confidence with the oral presentation. The conference chair takes great care not to “unblind” the presenting resident to the final diagnosis or provide any additional content to the prepared case presentation. The Conference
Conference attendees typically include radiology and pathology attendings including departmental leadership, radiology and pathology trainees (residents and fellows), and rotating medical students. On conference day, the organizing
TABLE 1. Resident Rad-Path Conference Responsibilities Organizing Radiology Resident (PGY3) One month prior to conference
One week prior to conference
Conference day
2
Literature Review Radiology Resident (PGY3 or 5)
Selects cases and prepares PowerPoint presentation Meets with subspecialty radiology faculty mentor NA
NA
Serves as conference moderator; mediate discussion
Presents scholarly discussion for each case
Meets with faculty mentor to finalize and practice presentation
Presenting Radiology Resident (PGY 5)
Pathology Resident Receives case information from the organizing resident Prepares pathology case slides, differential diagnosis, and discussion Meets with the designated subspecialty pathology faculty mentor Meets with faculty mentor to finalize and practice presentation
Presents pathology slides, differential diagnosis, discussion, and the final pathology diagnosis
NA
Blinded to the case diagnosis: receives anonymized PowerPoint from the organizing resident Prepares case discussion and differential diagnosis Meets with conference chair to finalize and practice presentation Provides a focused, clear discussion of each case with a weighted differential diagnosis, including most common or likely diagnosis, and “zebras” Receives questions and feedback from audience
Academic Radiology, Vol ■, No ■■, ■■ 2017
resident serves as the conference moderator. The presenting resident provides a focused, clear discussion of each case with a weighted differential diagnosis. The pathology resident then presents images of the corresponding histologic pathology slides, differential diagnosis, discussion, and the final pathology diagnosis. Finally, the literature review resident presents the prepared academic discussion. These roles are repeated for each of the three cases per conference. After each presentation, the organizing resident solicits feedback from the audience. These important moments give the residents an opportunity to receive both questions and direct feedback on their presentations from the audience, and demonstrate mastery of the material they have presented.
ORAL CASE PRESENTATION REVIVAL IN RESIDENCY
orally, compared to fourth-year residents trained under the old ABR examination format (Table 3). Participants
Thirteen radiology residents responding to the survey had directly participated in the Rad-Path conferences in one of the four possible roles delineated earlier. Eighty-five percent (11 of 13) either agreed or strongly agreed that residents were given significant autonomy and that the conference was “resident-run.” Additionally, 69% (9 of 13) either agreed or strongly agreed that the Rad-Path conference had improved their confidence and/or ability to present case information orally.
Assessment Attendees
To assess whether the goals of the Rad-Path conference were being achieved, we created an anonymous online survey for trainees and attendings in both the radiology and pathology departments. The survey questions are summarized in Table 2. Questions were presented as multiple-choice answers. A 5-point Likert scale (strongly agree, agree, neither, disagree, and strongly disagree) comprised the majority of questions. Percentages were examined for each variable. For several survey questions, we examined whether there was a statistically significant difference between radiology trainee and attending groups by using the Mann-Whitney U test for ordinal variable significance. Statistical analysis was performed using STATA 14.0 (StataCorp, College Station, TX). RESULTS Respondents
Our survey respondents consisted of 87 radiologists and 32 pathologists. Among radiologists, 60% (52 of 87) were attendings and 40% (35 of 87) were trainees (9 PGY2, 6 PGY3, 7 PGY4, 6 PGY5, and 7 fellows). Among pathologists, 47% (15 of 32) were attendings and 53% (17 of 32) were trainees (5 PGY1, 4 PGY2, 6 PGY3, 2 PGY4). Context
The majority (20 of 35, 57.1%) of radiology trainees either agreed or strongly agreed with the statement: “I wish I felt more comfortable with oral presentations” (Table 2). The majority of radiology attendings (34 of 52, 65%) either agreed or strongly agreed that the residents should be more comfortable with oral case presentations. Radiology attendings who responded “yes” to having mentored residents in preparation for both the old and new American Board of Radiology (ABR) board examinations were asked to compare residents trained under the two formats. Twenty-eight of 38 (74%) responding radiology attendings believed that fourth-year residents examined with the new ABR board examinations were either less prepared or significantly less prepared to present cases
Fifty-nine percent (51/87) of radiologists responding to the survey had attended at least one Rad-Path conference in person (excluding remote attendees through teleconference at offsite locations). Forty-one percent (36/87) of the respondents had not attended any Rad-Path conference. Of those who did not attend, 9 of 36 were first-year residents and 3 of 36 were fellows who completed the survey prior to the start of the annual Rad-Path conference. The remainder included 24 attendings with conflicting clinical responsibilities. We asked those respondents who had attended at least one Rad-Path conference whether the conference had improved their ability to formulate a differential diagnosis and/or improved their appreciation for the fields of radiology and pathology. Of the radiology trainees in this group, 83% (19/23) agreed or strongly agreed that the conference had improved their ability to formulate a differential diagnosis, 83% (19/23) agreed or strongly agreed that the conference had improved their appreciation for radiology, and 83% (19/23) agreed or strongly agreed that the conference had improved their appreciation for pathology. Of the radiology attendings in this group, 61% (17/28) agreed or strongly agreed that the conference had improved their ability to formulate a differential diagnosis, 68% (19/28) agreed or strongly agreed that the conference had improved their appreciation for radiology, and 71% (20/28) agreed or strongly agreed that the conference had improved their appreciation for pathology. Radiology attendees (39.2%, 20 of 51), including attendings and trainees, felt that attendance at the conference increased their confidence or ability to speak with clinicians. Of the attendees who were radiology trainees, 34.8% (8/23) agreed or strongly agreed that attending the conference increased their confidence or ability to speak with clinicians. Using the Mann-Whitney U test, no significant difference was found between radiology trainees and attendings. DISCUSSION With the transition of the radiology board examination from oral to written format, case communication skills are practiced and tested less than in the past. This may have important 3
SOTARDI ET AL
Academic Radiology, Vol ■, No ■■, ■■ 2017
TABLE 2. Radiology Attendings and Trainees’ Experience with Rad-Path Conference Questions Both attendings and trainees Have you attended the Rad-Path conference? Yes No What is your level of training? PGY2 PGY3 PGY4 PGY5 Fellow Attending Rad-Path conference increased my appreciation for the field of radiology. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path conference increased my appreciation for the field of pathology. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path conference helped me learn about formulating a differential diagnosis. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path conference increased my confidence or ability to speak with clinicians. Strongly agree Agree Neither Disagree Strongly disagree Trainees only Rad-Path is a “resident ran” conference, meaning that I had a significant amount of autonomy in devising the presentation. Strongly agree Agree Neither Disagree Strongly disagree Participating in Rad-Path conference increased my confidence and/or ability to present case information orally. Strongly agree Agree Neither Disagree Strongly disagree I wish I were more comfortable giving oral presentations. Strongly agree Agree Neither Disagree Strongly disagree Attendings only The residents ought to be more comfortable giving oral presentations. Strongly agree Agree Neither Disagree Strongly disagree Rad-Path, Radiology-Pathology.
4
Number
Percent
51 36
59 41
9 6 7 6 7 52
10.3 6.9 8.0 6.9 8.0 59.8
16 22 8 3 2
31.4 43.1 15.7 5.9 3.9
11 28 8 3 1
21.6 54.9 15.7 5.9 2.0
8 28 11 4 0
15.7 54.9 21.6 7.8 0
5 15 22 5 4
9.8 29.4 43.1 9.8 7.8
7 4 2 0 0
53.8 30.8 15.4 0 0
6 3 3 1 0
46.1 23.1 23.1 7.7 0
5 15 10 5 0
14.3 42.9 28.6 14.3 0
20 14 16 2 0
38.5 26.9 30.8 3.8 0
Academic Radiology, Vol ■, No ■■, ■■ 2017
ORAL CASE PRESENTATION REVIVAL IN RESIDENCY
TABLE 3. Radiology Attendings and Trainees’ Perceived Competence by Board Format How Has the New Radiology Board Examination Format (ABR Core Examination) Altered the Ability of 4th Year Residents to Take Cases? Significantly LESS capable than oral board preparation Slightly LESS capable than oral board preparation About the same as oral board preparation Slightly MORE capable than oral board preparation Significantly MORE capable than oral board preparation
negative implications practically in the current environment, where radiologists are being encouraged more than ever to “come out of the dark” and engage both referrers and patients. Formal case preparation and discussion has the potential to help in achieving that goal. Case preparation requires the deliberate extraction, arrangement, and presentation of patient clinical and imaging information. Focused faculty mentoring teaches residents the skills to more effectively communicate his or her thought process in an ordered and focused manner. The opportunity to practice and hone these skills, while receiving custom-tailored feedback from faculty mentors, is invaluable for residents, and may be useful to them throughout their professional careers. Surveyed radiology trainees at all levels perceived a need for improvement in resident oral case presentation skills (57%), and surveyed attendings (65%) agreed with this need. Importantly, 69% of residents who presented at a single RadPath conference felt that the experience significantly improved their confidence and/or ability to present case information orally. In contrast to the trainees who directly participated in the presentation of cases, only 34.8% (8/23) of radiology trainees who merely attended the conference either agreed or strongly agreed that the conference increased their confidence or ability to speak with clinicians. This suggests that the act of presenting at the conference, as opposed to attendance alone, yields added benefit to the education of trainees. Because residents stand to benefit from the skills learned during Rad-Path conferences, we believe that these programs should be expanded across residency programs, so that all radiology residents are given opportunities to hone these important skills. Our findings confirm prior studies on the benefits of resident-driven educational conferences to radiology pedagogy. Several studies have demonstrated that residentprepared lectures were an effective means of teaching residents (1–4). Donovan et al. found that the majority of radiology residency program directors agreed that it is important for residents to teach (98%) and that these teaching experiences helped residents become better radiologists (85%) (3). Jafri et al. assessed the impact of a formal Rad-Path correlation conference held by medical students mentored by radiology faculty (5).
Number
Percent
11 17 10 0 0
28.9 44.7 26.3 0 0
In their study, 117 students (83%) felt that the session improved their understanding of the longitudinal care of patients, and 84% of students preferred the student-facilitated format to a resident-ran conference. Our survey data indicate that a resident-led Rad-Path conference addresses important aspects of resident training, increases interdisciplinary appreciation, and facilitates the exchange of knowledge between the radiology and pathology communities. By training residents in the art of oral presentation, we invest in the future of the field of radiology and ensure that it remains integrated and relevant both to the wider healthcare community and to the care of patients. ACKNOWLEDGMENTS The authors would like to acknowledge the dedicated work of our residents and our Radiology-Pathology conference faculty, without whom this would not be possible. Our Radiology faculty mentors (past and present) include: Dr. Beverly Thornhill, Dr. Shari Friedman, Dr. Richard Zampolin, Dr. Jessica Kurian, Dr. Sarah Oh, Dr. Mariya Kobi, Dr. Linda Broyde-Haramati, Dr. Anna Shmukler, and Dr. Beatriu Reig. Our Pathology faculty mentors include: Dr. Esperanza Villanueva-Siles, Dr. Karen Weidenheim, Dr. Michelle Ewart, Dr. Kathryn Tanaka, Dr. Qiang Liu, Dr. Perry Cohen, Dr. ChangCheng Zhu, and Dr. Susan Fineberg. REFERENCES 1. Collins J, Miller SS, Albanese MA. Resident learning and knowledge retention from resident-prepared chest radiology conferences. Acad Radiol 1997; 4:732–735. 2. Linaker KL. Pedagogical approaches to diagnostic imaging education: a narrative review of the literature. J Chiropr Humanit 2015; 22:9–16. 3. Donovan A. Radiology residents as teachers: current status of teaching skills training in United States residency programs. Acad Radiol 2010; 17:928–933. 4. Mainiero MB, Collins J, Primack SL. Effectiveness of resident-prepared conferences in teaching imaging utilization guidelines to radiology residents. Acad Radiol 1999; 6:748–751. 5. Jafri NF, Nadgir R, Slanetz PJ. Student-facilitated radiology-pathology correlation conferences: an experiential educational tool to teach multidisciplinary patient care. J Am Coll Radiol 2010; 7:512–516.
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