Hand-picking cases for resident interpretation can enhance teaching, learning experience

A novel approach to interpreting radiology reports alongside residents could cut an attending’s stress levels while increasing enjoyability and time, states a new editorial published in Academic Radiology this month.

A number of responsibilities compete for a seasoned radiologist’s time each day, Ronald L. Eisenberg, MD, JD, wrote in the article. Since federal regulations have lowered reimbursement rates for radiology exams in recent years, academic radiologists are working to maintain their clinical revenues and personal income, improve the quality of their services and train onsite residents.

“The field of radiology continues to expand, and every year, there is more to learn to become a competent radiologist,” Eisenberg wrote. “Not only is a strong knowledge base required, but also residents must spend enormous amounts of time reading cases on the clinical services. This clinical experience is most valuable when supervised by faculty interested in their education and willing to devote even small amounts of time teaching them the fine points of image interpretation.”

One-on-one lessons in the radiology reading room can be some of the most invaluable to a resident, Eisenberg said. He called PACS shifts with an attending a “cornerstone” of a resident’s education that could make or break their understanding of both normal and complex findings, yet first-year residents are typically confined to reading randomly selected studies pulled from a daily worklist. At Beth Israel Deaconess Medical Center in Boston, Eisenberg’s beginning residents read around 20 percent of chest radiographs seen each day.

Because of the often-randomized nature of this workflow, residents could be missing valuable, teachable moments, Eisenberg wrote. A resident and an attending radiologist probably aren’t interacting much within a reading room as is, and since disrupting workflow can be a source of inaccurate reporting, attendings don’t frequently call residents over to discuss a case.

“An alternative approach used by the author is for the attending to select cases with teaching value for the resident to interpret,” Eisenberg wrote. He said his residents are restricted to posteroanterior and lateral examinations for their couple of days on chest service, which allows them to develop a pattern for viewing conventional chest radiographs with largely normal appearances.

Following this initial period, Eisenberg said an attending can then select cases for the resident that demonstrate basic abnormal findings, as well as how physiological factors can influence the appearance of structures on conventional radiographs. He said that as an attending, he assigns every case with a misplaced tube or catheter, pneumothorax or pneumonia to his residents, who are then exposed to a range of critical findings during rotation and can become proficient in detecting those abnormalities.

Eisenberg said his approach is a way to maximize a resident’s learning experience while minimizing any extra work or time on the attending’s part. It also ensures the attending will enjoy the experience, rather than relying on conventional exams to teach residents everything they need to know.

“Over the past few years, first-year residents on the chest rotation have responded enthusiastically to being given cases selected for their teaching value rather than ones randomly taken from the general PACS worklist,” he wrote. “Moreover, as the author can attest, the readouts are much more satisfying. The selected case system is beneficial for residents and attendings alike.”