Peer Learning is Paving the Way Toward Continuous Improvement

Headshot of Jennifer Broder, MDJennifer Broder, MD, vice chair of Quality and Safety, Lahey Hospital and Medical Center Department of Radiology, and Vice Chair, American College of Radiology® (ACR®) Commission on Quality and Safety, contributed this post.

Continuous improvement is the dedication to the proposition that we can always become better. One of the necessary features of continuous improvement in our clinical work is ensuring that we have a system in place to identify our clinical errors, consider why they happened and learn from them. For many years in radiology, a formal documented random score-based peer review model has been used as one of the tools to accomplish this.

What we all know, though, is that while this score-based peer review model was running in the foreground, in the background during the course of our daily work we have been tapping each other on the shoulder, leaving each other notes in our mailboxes or sending emails saying, “Hey, take a look at this. Thought you would want to know.” More often than not, that communication was for cases that had  presented challenges, potential misses, things that people felt we would  struggle to discuss as “teachable moments.” We would privately look, wince, learn and gather the courage to move on.

Over the past few years, there has been a group of radiologists who have been asking the questions: What if we could reduce the shame associated with the identification of those errors? What if we could bring all that learning out into the open so that not just one radiologist learns from their mistake, but we all learn together? Would that help us collectively improve our performance? If so, could we do without the scoring aspect altogether? The model of peer review that has resulted from those conversations has been named “peer learning” and is described in the 2016 sentinel article Peer Feedback, Learning and Improvement: Answering the Call of the Institute of Medicine Report on Diagnostic Error published in Radiology. In a peer learning model, cases with learning opportunities—whether discrepancies or great calls—are identified during the course of one’s regular work day, submitted to a central coordinator with description, but without scoring or other expression of judgement, and then the feedback is shared with the interpreting radiologist for feedback. The coordinator chooses the highest yield cases to share with the rest of the community, most often anonymously during departmental cases conferences. Further, the learning from these conferences is then channeled into generating systems improvements.

Across the country, we’re seeing an increasing awareness of peer learning and adoption across diverse practices — whether your practice is small or large, academic or private, diagnostic or interventional, we are seeing that peer learning can be implemented anywhere. Enthusiasm for the model is growing rapidly.  Almost 370 people signed up for the recent American College of Radiology® Implementing Peer Learning webinar, during which nine panelists from various practice settings across the country joined me to help answer people’s questions about how to gain support for the transition and manage the practice details of program implementation.

Transitioning to peer learning takes some work, but it well worth the effort, and there are many more resources to help you. For instance, there is also the 2017 article Practical Suggestions on How to Move From Peer Review to Peer Learning which helps guide implementation and video recordings from the ACR-sponsored National Peer Learning Summit.

  • Does your facility practice peer review or peer learning? How do you think a shift toward peer learning will impact the culture at your institution?

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Working Together – and with Others – to Move Radiology Forward

Headshot of Dr. Howard B. Fleishon with dark gray background

Howard B. Fleishon, MD, MMM, FACR, chair of the American College of Radiology® (ACR®) Board of Chancellors, contributed this post.

The ACR is working with more than 50 other national medical societies to avert reimbursement cuts due to the Medicare Physician Fee Schedule evaluation and management (E/M) code changes that will soon go into effect.

The COVID-19 pandemic has already caused a major disruption and financial hit to various specialties within the healthcare provider community – including radiology. As patients begin to return for care, the recovery for many practices may be slow. Any further reimbursement reductions may jeopardize their ability to serve their patients.

As you may know, the ACR has created and gathered a number of microsites with resources to help us through this largely unprecedented national health event.

Now, many areas are beginning to reopen. Please know that we continue to work on your behalf to help you and your practice recover from COVID-19 and provide the best care to your patients.

Together, we are weathering the storm. And together, we will move the profession forward – whatever the future may bring.

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Case in Point Celebrates 15 Years of Continuing Education

Headshot of Kitt Shaffer, MD, PhD, FACRKitt Shaffer, MD, PhD, FACR, chief editor of the American College of Radiology® (ACR®) Case in Point®, contributed this post.

This month, we are proud to celebrate the 15-year anniversary of the American College of Radiology® (ACR®) Case in Point®. Case in Point is an educational resource provided free to ACR members, residents in radiology-related programs and medical students interested in radiology. Users are emailed a new case daily and can also access our online case archive and claim SA-CME credits for their participation.

Since the inception of Case in Point, we have developed a repertoire of almost 4,000 cases in our library, with an increase of over 251% since 2010. We are proud to share that our total number of completions has reached 4,301,139 cases.

Most recently, we have aimed to provide further support to the radiology community as we continue to navigate COVID-19. All submitted COVID-19 cases are now available as public access and are continually updated online.

Additionally, we are moving towards implementing a new online submission process starting Wednesday, July 8. Authors will have the capability to enter case data directly into our system for conversion to a case. Any necessary edits will be made over email prior to case creation.

As we look to the future, we are excited to share our new global health initiative in collaboration with RAD-AID. Together, we are working to enhance the delivery of Case in Point to RAD-AID’s partnered, resource-poor hospitals in low and middle-income countries. Our efforts will strengthen the accessibility and quality of training materials available to medically underserved regions worldwide.

Join us in celebration this month as we reflect on the past 15 years of Case in Point and look to the future of how we will continue to support the education of ACR members, radiology residents and medical students around the globe.

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