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The Radiology Readout: How Much Does It Matter?

2021; Radiological Society of North America; Volume: 41; Issue: 1 Linguagem: Inglês

10.1148/rg.2021200023

1527-1323

Farouk Dako, Omer A. Awan,

Radiology practices and education

HomeRadioGraphicsVol. 41, No. 1 PreviousNext EditorialsFree AccessEducation CornerThe Radiology Readout: How Much Does It Matter?Farouk Dako, Omer A. Awan Farouk Dako, Omer A. Awan Author AffiliationsForm the Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201.Address correspondence to O.A.A. (e-mail: [email protected]).Farouk DakoOmer A. Awan Published Online:Jan 7 2021https://doi.org/10.1148/rg.2021200023MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In When we gather together in the moonlit village ground it is not because of the moon….We come together because it is good for [us] to do so.Chinua Achebe (1)Awaken people's curiosity. It is enough to open minds, do not overload them. Put there just a spark.Anatole France (2)The radiology readout is a fundamental academic practice involving the radiology trainee and trainer where active learning occurs, personal connections are made, and work is accomplished. This radiology equivalent of rounding on patients has evolved because of the digitization of imaging but remains the cornerstone of the workday in the academic setting and is an essential component of radiology education for trainees.The approach to the readout varies among attending radiologists and is likely influenced by the workload, the interpersonal relationship between the trainer and trainee, and the culture of the reading room. One style is dominated by the trainee observing the trainer interpreting studies, while the trainee meticulously takes notes. An almost opposite approach is the trainer listening to the trainee show their observations and, if needed, the trainer explaining their thought process. No one approach is perfect; trainee preference is usually influenced by level of experience, engagement, and confidence and by type of work shift. Given current high study volumes, daily readouts are often a combination of initial independent resident review, joint resident and attending review, and sole attending review.Did you ever have an attending radiologist who conducted the readout in your 4th year of residency training the same way that they did in your 1st week? When this happened to me, I found it quite demoralizing to think that my role in the readout had not changed over the years. Training programs need more discussion about the significance of the readout, including the preferences and expectations of all parties involved, with a plan for individualized progression over time. At the start of training, there is value in observing attending radiologists review cases, make observations, and generate reports to learn search patterns, radiologic terminology, and report generation. However, readouts should evolve over time with emphasis on increasing trainee independence and leadership. Attendings should then take a supervisory role, intervening and providing feedback as needed. This structure is equivalent to a surgical resident performing an operation while the attending, who is scrubbed in, provides guidance and feedback as needed.A passive role for a trainee in a readout, limited to observing and note taking, could curb their enthusiasm for the field and ultimately stunt their growth as a radiologist despite the best efforts of the attending to pass on knowledge and be engaging. This could hamper resident confidence when increased independence is required, such as when on call, and increase the time required to feel comfortable in the role of attending radiologist. A presenter role for the trainee provides practice in the description and critical analysis of imaging findings, crucial skills for functioning as a competent radiologist in practice. How can we expect our trainees to grow intellectually and professionally if we are spoon-feeding information to them for their entire residency training?Readout styles can have a profound effect on camaraderie and burnout as well. My favorite readouts had a good balance of social and educational elements, starting off with an exchange of pleasantries, continuing with an exchange of information interwoven with banter, and concluding with plans for the next meet-up. My least favorite readouts felt like a visit to the principal's office. I had a simple plan to listen, nod, and agree, to make it as quick as possible. As a resident, I looked forward to readouts with certain attendings because of the experience of learning, working, and feeling competent about myself as a radiologist, which made the process effortlessly fun. Inclusion of medical students in readouts supports the team approach to patient care. They can be tasked with duties like reviewing patients' charts and presenting a brief relevant patient history, and they should be encouraged to make observations as cases are reviewed. Medical students and radiology trainees are adult learners, and they need to feel like they are part of the learning experience to thrive and retain meaningful information.I often experienced some signs of burnout and low self-esteem after a shift that included dictating numerous radiography reports for which I wasn't the primary interpreter but largely acted as a scribe, vigorously writing notes in a dark room while my attending described findings and their meaning. No readout style is perfect, but effort should be made to tailor the readout to the training level and interest of the trainee. Trainers and trainees should discuss their preferred style of readout at the start of a rotation or shift, with an eye on maintaining efficiency and educational relevance. Inclusion of supplementary material such as cases from one's personal teaching file and other point-of-care resources can provide increased educational relevance. Trainee level-specific questions and differential diagnosis discussion help maintain engagement.Instructive conversations regarding quality assurance and improvement, the appropriateness and comparative effectiveness of imaging studies, health care economics, and population health could occasionally take place at the readout. For example, a readout of a CT angiogram of the thorax for pulmonary embolism could start with the attending asking the resident if they think the study was appropriate for the patient, leading to a brief conversation about the American College of Radiology appropriateness criteria for chest pain. A question could be asked about whether the study was performed optimally, leading to a conversation about quality assurance and improvement. While it might be impractical for this type of conversation to always happen at readouts, it should happen occasionally for active learning to occur.Diverse readout workflows have emerged with the digitization of imaging, including remote readouts that are done over the phone and the "no readout," which involves sending dictated cases to an attending with or without the expectation of feedback. The remote readout is sometimes a necessity owing to the large size of imaging enterprises and the incorporation of teleradiology, which requires an individual to read from multiple remote sites. The "no readout" is viewed as ideal for shifts when volumes are high, efficiency is paramount, and resident autonomy is essential. This style supports growth in trainee confidence and speed and allows increased ownership of the report, especially if the preliminary report is visible to the entire hospital system. Feedback can be given through instant messaging, which is available in some picture archiving and communication systems (PACS), or by phone. The absence of a traditional readout (where trainer and trainee sit side by side and systematically discuss findings and interpretations of cases) increases isolation in the workplace and limits other important activities that can occur during readouts, such as social interactions, conversations that lead to research questions, collaboration, and opportunity for mentorship. A hybrid approach with the readout conducted after the trainee sends the dictated cases to the attending could combine the benefits of the traditional readout with that of the "no readout."The readout style indirectly sets expectations and influences the perceived value of the trainee to the team. Although readout styles vary among attendings, they tend to be more similar within reading rooms and divisions. For example, in certain divisions a "no readout" is the predominant approach, while versions of the traditional readout dominate in others, regardless of trainee level of experience. This demonstrates the association between readout style and reading room culture.The effect of the readout on trainee education is profound but often overlooked, perhaps because it is unknown or underestimated. In this generation of trainees who undertake a large portion of their medical school education from the comfort of their laptop at home and not in a lecture hall, education from readouts may not be as cherished. It is therefore important to engage in discussions that are not limited to imaging interpretation and impression of the cases being reviewed. There is no better place to learn about technical considerations, such as whether a study was appropriately protocoled or performed, whether multiplanar views were correctly reconstructed, or what artifacts are present on an image, than at the readout. These educational pearls would be difficult to learn and understand without the reading room experience. So when we gather together in the dimly lit room, let us remember that it is also a time for learning, providing inspiration, facilitating professional growth, and building camaraderie.References1. Achebe C. Things fall apart. 1958. New York, NY: Anchor, 1994; 178. Google Scholar2. Kelbrat T. The "people power" education superbook: book 1. How we think, learn & study. Morrisville, NC: Lulu Press, 2014. Google ScholarArticle HistoryReceived: Mar 2 2020Revision requested: Mar 5 2020Revision received: Mar 5 2020Accepted: Mar 13 2020Published online: Jan 7 2021Published in print: Jan 2021 FiguresReferencesRelatedDetailsCited ByResults of the 2021-2022 Survey of the American Alliance of Academic Chief Residents in RadiologyAllisonKhoo, ChristopherHo, David H.Ballard, Jennifer E.Gould, Kaitlin M.Marquis2023 | Academic RadiologyPreserving the Spirit of Lifelong LearningOmer A.Awan2022 | Academic Radiology, Vol. 29, No. 1The Impact of the COVID-19 Pandemic on Radiology Resident Education: Where Do We Go From Here?Nikhil S.Patil, DaneGunter, NatashaLarocque2022 | Academic Radiology, Vol. 29, No. 4Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70CiaranGrafton-Clarke, HusseinUraiby, MorrisGordon, NicolaClarke, EliotRees, SophiePark, MohanPammi, SebastianAlston, DeenaKhamees, WilliamPeterson, JenniferStojan, CameronPawlik, AhmadHider, MichelleDaniel2022 | Medical Teacher, Vol. 44, No. 3Recommended Articles Deep Learning for Pulmonary Embolism Detection: Tackling the RSNA 2020 AI ChallengeRadiology: Artificial Intelligence2021Volume: 3Issue: 5Yield of CT Pulmonary Angiography in the Emergency Department When Providers Override Evidence-based Clinical Decision SupportRadiology2016Volume: 282Issue: 3pp. 717-725Adapting Scientific Conferences to the Realities Imposed by COVID-19Radiology: Imaging Cancer2020Volume: 2Issue: 4Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine MapsRadiology2018Volume: 289Issue: 2pp. 546-553Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of WashingtonRadiology2020See More RSNA Education Exhibits Dual-Energy CT for Acute Pulmonary Artery Embolism: How "To Do It": Imaging Pearls, Benefits, and PitfallsDigital Posters2019Dual-Energy CT for Acute Pulmonary Artery Embolism: How "To Do It" - Imaging Pearls, Benefits and PitfallsDigital Posters2020Imaging of Suspected Pulmonary Embolism and Deep Venous Thrombosis in Obese PatientsDigital Posters2020 RSNA Case Collection Pulmonary Embolism with Right Heart StrainRSNA Case Collection2020Acute pulmonary embolismRSNA Case Collection2022Pulmonary Infarct RSNA Case Collection2020 Vol. 41, No. 1 Metrics Altmetric Score PDF download