Elsevier

Current Problems in Diagnostic Radiology

Volume 47, Issue 6, November–December 2018, Pages 387-392
Current Problems in Diagnostic Radiology

Towards Consensus: Training in Procedural Skills for Diagnostic Radiology Residents—Current Opinions of Residents and Faculty at a Large Academic Center

https://doi.org/10.1067/j.cpradiol.2017.09.012Get rights and content

Rationale and Objectives

The Diagnostic Radiology Milestones Project provides a framework for measuring resident competence in radiologic procedures, but there are limited data available to assist in developing these guidelines. We performed a survey of current radiology residents and faculty at our institution as a first step toward obtaining data for this purpose. The survey addressed attitudes toward procedural standardization and procedures that trainees should be competent by the end of residency.

Materials and Methods

Current residents and faculty members were surveyed about whether or not there should be standardization of procedural training, in which procedures residents should achieve competency, and the number of times a procedure needs to be performed to achieve competency.

Results

Survey data were received from 60 study participants with an overall response rate of 32%. Sixty-five percent of respondents thought that procedural training should be standardized. Standardization of procedural training would include both the list of procedures that trainees should be competent in at the end of residency and the standard minimum number of procedures to achieve competency. Procedures that both residents and faculty agreed are important in which to achieve competency included central line/port procedures; CT-guided abdominal, thoracic, and musculoskeletal procedures; minor fluoroscopic-guided procedures; general fluoroscopy; peripheral line placements; and US-guided abdominal procedures. For most of these categories, most respondents believed that these procedures needed to be performed 6-20 times to achieve competency.

Conclusion

Both resident and faculty respondents agreed that procedural training should be standardized during residency, and competence in specific procedures should be achieved at the completion of residency. Although this study is limited to a single institution, our data may provide assistance in developing future guidelines for standardizing image-guided procedure training. Future studies could be expanded to create a national consensus regarding the implementation of the Diagnostic Radiology Milestones Project.

Introduction

In February 1999, the Accreditation Council for Graduate Medical Education (ACGME), which is primarily responsible1 for accrediting allopathic clinical residency and fellowship programs in the United States unveiled its Outcome Project.2 This report outlined a 10-year plan that defined 6 general competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice) thought to be common to physicians in training in all specialties.2 Within this framework, some specialties such as Cardiology, General Surgery, and Internal Medicine require a standardized list of procedures for which all candidates are expected to be competent at the completion of training.3, 4, 5 Furthermore, Cardiology and General Surgery require a minimum number of each procedure for board certification.3, 4 Rao6 published survey results of national Diagnostic Radiology program directors in 1996 which indicated that 74% of national program directors supported the concept of specifying procedures in which radiology residents should be trained.

In 2012, a joint initiative of ACGME and the American Board of Radiology published the Diagnostic Radiology Milestones Project which detailed competency-based developmental outcome expectations for graduates of Diagnostic Radiology residency programs.1 Within the purview of patient care and technical skills, the Milestones Project provides a framework for monitoring and measuring resident competence in radiologic procedures.1 The Milestones Project encompasses 6 domains of physician competency including patient care and technical skills, medical knowledge, system-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. Currently, there is no standardized list of radiologic procedures in which diagnostic radiology residents are expected to achieve competence prior to graduation.

Our study attempts to capture the opinions of residents and faculty within the radiology department of a large academic center regarding resident competency in image-guided procedures and seeks to identify a consensus between residents and faculty. Our academic center training facilities encompass a 900+ bed level 1 trauma center, 500+ bed tertiary care hospital, and a 500+ bed community subspecialty hospital. For example, at our tertiary care hospital and community subspecialty hospital, over 600,000 examinations were performed in 2014. We believe that such information will be useful additions for future development and implementation of the Milestones Project1 and provide insight into the experiences of residency graduates over the course of their training.

Section snippets

Materials and Methods

This HIPAA-compliant study was approved for exempt status by the Institutional Review Board of BLINDED. Survey data were collected anonymously.

An electronic survey regarding procedural competency (Appendix A) was sent to all residents and faculty of the BLINDED. The survey was sent via an e-mail listserv to all residents, fellows, and clinical faculty at our institution. Respondents were given 2 weeks to respond. For the purposes of this study, only clinical faculty in diagnostic radiology or

Results

The survey was sent to 61 residents and 124 faculty members. There were 60 total respondents: 17 residents, 41 faculty, and 2 that did not specify resident or faculty status. This corresponds to overall response rates of 32%; 33% among identified faculty and 28% among identified residents. Faculty subspecialties and years of practice after residency are shown in Table 1, organized into 2 groups based on greater than 10 years of experience. A roughly symmetrical representation of specialties was

Discussion

The Diagnostic Radiology Milestones Project provides a framework for assessing resident competence in radiologic procedures,1 but we believe that there are limited published data available to guide the choice of procedures a resident should be competent at, or to guide criteria for the evaluation of procedural competence. We performed a survey of the current residents and faculty at our institution as a first step toward obtaining data for this purpose.

A clear definition of procedural

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    Ultrasound procedural basic competency was felt to be achieved by the majority in the ranges 6-10 and 10-20 whereas there was more majority consensus that mammography-guided procedural competency may be achieved with overall fewer at 6-10 likely reflecting the lack of hand-eye coordination skill needed for mammogram guided biopsies. Competency is of course not based on the number of procedures performed, but rather on multiple factors that faculty assess 12, however this question was asked to get a general estimate regarding typical number of procedures that residents should have minimum access to during their residency and is similar to the findings from a single institution survey of faculty.13 Ultrasound procedural competency requires hand-eye coordination that trainees develop at different rates, whereas mammogram guided procedures are technically more straightforward in the majority of cases.

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