Audiovisual content for Radiology Fellowship selection process: A pilot study using online questionnaires with smartphones in the time of the COVID-19 pandemic. (Preprint)

UNSTRUCTURED Traditional radiology fellowships are usually one or two year clinical trainings in a specific area after completion of a four-year residency. Our purpose was to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format, using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the Coronavirus Disease 2019 (COVID-19) pandemic. Our hypothesis is that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and also facilitate understanding of imaging findings of radiology-based questions, while maintaining social distancing. One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using online questionnaires for 123 fellowship applications for musculoskeletal (39), internal medicine (61) and neuroradiology (23) programs to evaluate the experience of using audiovisual radiology content as a complementary material for the conventional text evaluation. Positive responses were statistically significant in most questions. Use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance of the applicant’s experience during this process. This technology also allows for the evaluation of candidates without the necessity of in-person interactions. Further studies could streamline these methods in order to minimize work redundancy with traditional text tests or even evaluate the acceptance of using only audiovisual content using smartphones.

P040: Retrospective assessment of discrepancies in preliminary radiological reports in the emergency department

Background: Preliminary reports and subsequent immediate management decisions of radiological scans are often performed by emergency physicians and on-call radiology residents. Many academic hospitals have resident-only coverage for after-hour shifts. Generally, these preliminary reports are eventually reviewed by a staff radiologist, during which discrepancies may be identified. Depending on the severity of the discrepancy and the time taken to notify the treating physician, there is potential for significant impact on the patient's care. Aim Statement: In an attempt to identify and minimize errors in radiological readings, and to improve the communication of discrepancies, our project aims to retrospectively audit all radiological discrepancies that have occurred at The Ottawa Hospital's emergency departments from April 2018 to May 2019. Measures & Designs: A systematic review of all cases with noted radiological discrepancies was obtained from the Picture Archive and Communication System software and EPIC platform. Analysis of these cases will allow us to define when errors occur, what is the type and severity of the error, how long it took to relay the discrepancy to a treating physician, and what was the subsequent management impact. Evaluation/Results: We discovered 712 cases with radiological reading discrepancies, 168 major, 527 minor, and 17 incidentals. Interestingly, a significant portion of major (severely affecting care/life-threatning) discrepancies were reported from radiology residents, especially on CT images, although emergency physicians had the most discrepancies (mostly minor). Radiology residents were seen to have more discrepant reports during after-hour services while emergency physicians did not show any specific pattern of discrepant reporting. The average time to report a major discrepancy to a treating physician is 8.8 hours, where the maximum time taken was 104 hours and the minimum was 0.2 hours. 56% of reports with major discrepancies made no mention of who was notified. Discussion/Impact: By identifying weak points in radiological reporting, our results will allow us to provide suggestions at an administration and teaching level to minimize discrepancies. It is critical to create a workflow where mistakes are mitigated, and communication is efficient and standardized to prevent patient harm from delayed or incorrect diagnosis.

Increasing Neuroradiology Exam Volumes On-Call Do Not Result in Increased Major Discrepancies in Primary Reads Performed by Residents

Background and Purpose: A common perception is that increased on-call workload leads to increased resident mistakes. To test this, we evaluated whether increased imaging volume has led to increased errors by residents. Materials and Methods: A retrospective review was made of all overnight neuroradiology CT exams with a primary resident read from 2006-2010. All studies were over-read by staff neuroradiologists next morning. As the volume is higher on Friday through Sunday nights, weekend studies were examined separately. Discrepancies were classified as either minor or major. “Major” discrepancy was defined as a discrepancy that the staff radiologist felt was significant enough to potentially affect patient care, necessitating a corrected report and phone contact with the ordering physician and documentation. The total number of major discrepancies was recorded by quarter. In addition, the total number of neuroradiology CT studies read overnight on-call was noted. Results: The mean number of cases per night during the weekday increased from 3.0 in 2006 to 5.2 in 2010 (p<0.001). During the weekend, the mean number of cases per night increased from 5.4 in 2006 to 7.6 in 2010 (p<0.001). Despite this increase, the major discrepancy rate decreased from 2.7% in 2006 to 2.3% in 2010 (p=0.34). Conclusion: Despite an increase in neuroradiology exam volumes, there continues to be a low major discrepancy rate for primary resident interpretations. While continued surveillance of on-call volumes is crucial to the educational environment, concern of increased major errors should not be used as sole justification to limit autonomy.