RSNA: Integrating rad resident with primary care team can bridge gap left by PACS

CHICAGO—The addition of a PGY4 radiology resident (PGY4RR) to a large pediatric clinical team received strong support, and enhanced the team’s knowledge of imaging findings, exam indications and increased their likelihood to provide more history, according to researchers of a single-center study presented Nov. 26 at the annual meeting of the Radiological Society of North America (RSNA).

Traditionally, many clinical services rounded in the radiology department allowing residents to learn core competencies such as communication skills, patient care and system-based practice. However, with the introduction of PACS, this interaction has become progressively less frequent because the need for personal communication was less necessary, said the lead author Munir Patel, BS, who presented the study conducted at Children's Mercy Hospitals and Clinics in Kansas City, Mo.

“The pediatric primary care team at Children’s Mercy felt their trainees didn’t have enough radiology training, and the radiology department felt their trainees lacked in their communication skills,” explained Patel.

Before conducting the study, the researchers found that 55.55 percent of the primary care team interacted five times or less per year with a radiologist in person (resident or fellow), and more than one-quarter reported never interacting with a radiologist.

To bridge the gap, the researchers developed a pilot rotation incorporating a PGY4RR into the general pediatrics team, and they conducted this study to determine the support and benefit of this rotation to members of the pediatric clinical team.

Over a one-year period (October 2011-October 2012), six PGY4RR spent four weeks each rotating on general pediatrics. The PGY4RR’s responsibilities included:

  1. Daily presentation and discussion of imaging studies performed in the proceeding 24 hours;
  2. Assistance with decisions on future exams based on patient-specific imaging indications; and
  3. A review of any imaging as needed.

“While attending the primary care rounds, the radiology residents purpose was education only; they did not perform any clinical duties,” Patel explained. “They answered questions for the primary care team, and after rounds, would be tasked with researching any unanswered questions and prepare for the next day.” The residents were in their final year, so they had the knowledge base to answer most questions, but they also could consult with the radiology staff.

The researchers distributed a survey to pediatric primary care team members, including medical students, residents and attendings, to assess the value of the PGY4RRs. Thirty-three replied (18 medical students, 12 residents and three attendings).

Among the respondents, 62 percent, 25 percent, 0 percent and 13 percent of respondents were medical students, residents, fellows and attendings, respectively. Also, 67 percent of respondents stated they had a better understanding of radiology concepts after rotating with the PGY4RR.

Respondents stated that their understanding of exam indications (56 percent), and how studies were performed (67 percent) was improved. Ninety-four percent stated that having a PGY4RR on the team during rounds was beneficial to learning and if given the option, 83 percent would definitely want to rotate with a PGY4RR again on a clinical rotation, and 83 percent would want to rotate with a PGY4RR on rotations other than pediatrics. 

After this experience, 56 percent of respondents stated they were more likely to provide additional history when ordering imaging. “This will likely lead to more efficient and effective ordering of exams, as well as a likely cost savings,” Patel pointed out.

Also, 100 percent of the respondents from the primary care team felt the experience with the radiology resident was somewhat to very beneficial to their clinical experience and learning. And, 86 percent of the respondents said they would want a radiology resident on their other rotations.

The researchers concluded that this survey shows strong support for the addition of a PGY4RR to the pediatric clinical care team because team members felt the PGY4RR enhanced their understanding of radiology exam indications, concepts and knowledge. If given the option, the majority of respondents would choose to have a radiology resident on future pediatric as well as other rotations.