School is in Session for Radiology Residents, Even when Most Professors are Sleeping

One of the latest offerings in vRad’s service portfolio would make for a good chapter in How to Do More with Less in Radiology, should such a book ever get written. The new program is the teleradiology giant’s Virtual Resident Workflow (VRW), and the title of the chapter on it would be something along the lines of: “While You’re Interpreting, You Could Be Teaching Too.”

Like an attending radiologist who’s always available for everything related to reading patient imaging exams, VRW overreads participating residents’ radiology reports as quickly as residents can file them, accelerating and optimizing patient care—thank you, HL7—and sends attending radiologists and residency program leaders a comparison of the two reports for educational purposes. In this way, it seamlessly speeds and customizes resident training.

No, VRW is not an AI robot. It’s a flesh and blood, board-certified radiologist from amongst vRad’s roster of nearly 500 expert interpreters of medical imaging, 75% of whom are subspecialty-trained. All are enabled to use structured reporting, natural language processing, and auto-dial technology to send instant notifications on significant discrepancies and critical findings, 24/7.

And vRad’s analytics solutions provide participating residency programs with detailed statistical summaries of their residents’ performance over time. This information shows which residents need intensified training and, specifically, which facets of their reading patterns warrant particular attention.

“Rather than spending their mornings overreading and correcting preliminary studies from the previous night and trying to sign-out with sleepy night float residents, vRad client radiologists start their day focused on new patients,” says Samir Shah, MD, the vRad medical director who oversees the VRW program. This also improves patient throughput and improves ED and house staff satisfaction, he explains.

“With VRW,” he says, “we do those same overreads while simultaneously providing clinical instruction to your residents.”

Shah adds that VRW’s performance-analytics component is almost certainly unique within the sphere of radiological resident education.

“You don’t get that level of automated transparency, knowledge, and depth of data analysis from any teaching program I know of,” he says, adding that VRW is a natural outgrowth of vRad’s embrace of every category of information technology that can be put to the service of radiology.

“It’s really amazing how the technologies we’ve already implemented—things like natural language processing to expedite billing compliance, error finding and critical results communications—are now allowing us to support fairly complicated workflows like teaching residents,” Shah says. “Without those advances, we wouldn’t be where we are.”

Virtual attending rads, there when needed  

Where they are, geographically speaking, is in more than 2,100 client sites across the U.S. Such is the power of vRad’s scalable telemedicine reach. Meanwhile, other vRad advances to which Shah refers include patenting 15 workflow-improvement innovations and pioneering the use of deep learning to wring actionable intelligence out of massive imaging datasets acquired from multiple millions of imaging exams.

That’s a lot of clinical, technical and engineering firepower. Still, for all that, it’s often the human touch that ends up helping client hospitals, health systems, and practices better serve their referrers and care for their patients, Shah says.

“We have a radiologic protocol to help overnight residents and technologists with contrast decisions, for example,” says Shah. “It’s not unusual for our radiologists to help with those kinds of patient-safety decisions in the overnight hours when there’s no attending available onsite.”

vRad’s expertise in stroke and trauma protocoling often comes into play with residents as well. For example, the company is able to parcel out trauma studies between two or more vRad radiologists in order to cut read times. This adds up to major time savings when trauma patients arrive in the ER during the wee hours needing—sometimes for medicolegal as well as clinical purposes—imaging of the cervical, lumbar and thoracic spine, all three, on top of facial bones, chest, abdomen and pelvis scans.

“The residents are often the only ones there at night. And if you have two or three trauma patients from a single accident, suddenly the residents have more than 20 studies to get through,” says Shah. “By doubling or in some cases tripling the manpower, we get those studies read expertly and quickly.”

A little extra work for a lot of added value  

vRad designed Virtual Resident Workflow’s educational analytics with an eye on elegant simplicity, Shah says. When overreading a resident’s radiology report, the vRad radiologist checks off one of three boxes—“Radiologist agreed,” “Radiologist disagreed” or “Radiologist determined there were additional findings.”

This quick check is augmented by a summary of the comparison between the two reports, along with brief notations on imaging modalities, body parts and discrepancy patterns that may be emerging in the resident’s reads over time.

“We kept it all very simple because we didn’t want to change the client’s existing workflow—or ours—any more than we had to,” Shah says. “Someone could argue that having to read residents’ reports is inconvenient, but our radiologists actually want that information.”

The residents may have access to additional history, he points out, or they might catch something that helps the vRad expert help the resident.

“It’s just the nature of radiology that having another set of eyes is good,” Shah says, adding that consistently high-quality reads reassure referrers who may be skittish about working with radiology residents. “We certainly want to know what was said about the study before we interpret it, whenever that’s possible. We find that reading the residents’ reports is very little extra work with a lot of gain.”

Emergency medicine, anytime education   

Might the residents be intimidated knowing that their work is being observed from afar, with the chance they’ll be identified as outliers on quality? The team at vRad doesn’t think so.

“I think residents want objective teaching,” Shah says. “Residents are there to learn, and errors are going to occur. The great thing about our educational systems at our academic medical institutions is that, now more than ever before, they have a culture that is very much driving toward data-driven learning.”

Further matching VRW with that trend, the program includes online teaching files that give residents access to a trove of resident teaching files.

Another value-add is a complimentary online board-review course presented each September by vRad chief medical officer Benjamin W. Strong, MD.

“We’re excited to be helping the radiologists of tomorrow become better radiologists,” Shah says. “For years, the nighttime work was viewed as less important as the daytime work. But emergency radiology has now become a full-fledged subspecialty within radiology.

“Being able to teach residents at all hours—not just during daytime hours—is a great thing not just for radiology education but also for patient care.”