Rationale and Objectives
Introduce radiology residents to evidence-based radiology (EBR) using a journal club format based on the Radiology Alliance for Health Services Research/American Alliance of Academic Chief Residents in Radiology (RAHSR/A3CR2) Critical Thinking Skills sessions and EBR series of articles published in Radiology in 2007.
Materials and Methods
The club began with a presentation outlining the process that would occur in an alternating format, with topics and articles chosen by residents. In session A, questions were rephrased in a Patient/Population, Intervention, Comparison, Outcome format, and a literature search was performed. Articles were discussed in session B, with residents assigned by year to the tasks of article summary, technology assessment, and comparison to checklists (Standards for Reporting of Diagnostic Accuracy, Consolidated Standards of Reporting Trials, or Quality of Reporting of Meta-analysis). The residents collectively assigned a level of evidence to each article, and a scribe provided a summary.
Results
Twenty-two residents participated, with 12/22 (55%) of residents submitting any question, 6/22 (27.3%) submitting more than one question, and 4 residents submitting questions in more than one session. Topics included radiation risk, emergency radiology, screening examinations, modality comparisons, and technology assessment. Of the 31 articles submitted for review, 15 were in radiology journals and 5 were published before 2000. For 2/9 topics searched, no single article that the residents selected was available through our library’s subscription service. The maximum level of evidence assigned by residents was level III, “limited evidence.” In each session, the residents concluded that they became less confident in the “right answer.” They proposed that future reading recommendations come from attendings rather than literature searches.
Conclusion
A journal club format is an effective tool to teach radiology residents EBR principles. Resistance comes from the difficulty in accessing good literature for review and in constructing good review questions.
The significant evolution, explosion, and significance of medical imaging in today’s practice of medicine has made the process of both teaching and learning clinical and nonclinical radiologic skills a formidable task to accomplish during 4 years of residency . Practice-based learning and improvement is one of the Accreditation Council for Graduate Medical Education’s six general competencies that is particularly relevant to training today’s residents in diagnostic radiology, both because of the growth of medical imaging and the cost associated with this imaging . An introduction to the tools and process of evidence-based radiology (EBR) provides a forum for teaching and promoting practice-based learning in a diagnostic radiology curricula. A resident journal club facilitates the introduction of EBR into a diagnostic radiology resident education program . However, for such a curriculum to be successful, because it represents a change from traditional didactic and view-box teaching in radiology, it requires significant buy-in from program directors, faculty, and residents. At the 2007 Association of University Radiologists (AUR) meeting sessions on journal clubs, led by the late Ed Staub, MD, two main points were emphasized regarding journal clubs—the first that food must be provided and the second that it is unreasonable to expect everyone (or even most people) to have done the reading.
The structure from the Radiology Alliance for Health Services Research/American Alliance Chief Residents in Radiology (RAHSR/ACR3) Critical Thinking Skills sessions at the 2007 AUR meeting and the EBR series in Radiology ( ) was used as the model for a resurrected resident journal club at our intuition . Discussion and participation would be motivated by allowing the residents to pick the topics and the articles as well as lead the discussions. The educational experience would be ensured by using the club to introduce basic study design and statistical concepts and subspecialty faculty participation germane to the specific topics would be solicited. Lunch was provided for the conference through the residency director, because this program fulfilled goals of the Accreditation Council for Graduate Medical Education for teaching nonclinical skills.
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Materials and methods
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Results
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Table 1
Questions Submitted by Residents for Consideration in Journal Club
Question Search Topic (Y/N) Noncontrast CT of the belly for abdominal pain in ER patients N Ideal time for screening premature infant heads with us Y What is percent of those with a positive d dimer actually have a pulmonary embolus? N What percent of the time does a renal ultrasound or VCUG positive show an abnormality after a first UTI vs second UTI? N What does the radiology vs. neurosurgery vs. orthopaedic literature say about stable/unstable spine injuries? N What is the diagnostic value of RUQ or pelvic US in a patient who has a normal CT of the abdomen and pelvis with oral and IV contrast? ∗ Y Renal ultrasound on patients with acute renal failure. N Do abdominal CT examinations significantly increase the risk of childhood leukemia, growth retardation, etc. N What is the role of annual screening abdominal ultrasound for cirrhosis patients? Y Role of ultrasound in MSK imaging Y What is the utility of lumbar spine series with regard to low back pain, and no history of trauma? N What is the benefit of whole-body PET/CT in multiple myeloma? N How often is a PE study ordered from the ER positive? N How often are complex renal cysts diagnosed on US positive for malignancy on biopsy? ∗ Y Is CT pulmonary angiogram as good as pulmonary angiogram in the diagnosis of pulmonary embolism? Y What is the sensitivity/specificity of CT perfusion in ED patients with acute onset neurologic symptoms? N Is accuracy of diagnosis of acute appendicitis improved with oral contrast when compared to noncontrast CT? Y How should solitary pulmonary nodules be managed? ∗ Y What is the risk of radiation exposure from medical imaging? Y Assess the risk of radiation exposure from medical imaging? † Y
ER, emergency room; CT, computed tomography; VCUG, vesicoureterogram; UTI, urinary tract infection; RUQ, right upper quadrant; US, ultrasound; IV, intravenous; MSK, musculoskeletal; PET, positron emission tomography; PE, pulmonary embolism; ED, emergency department.
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Discussion
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Conclusion
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References
1. Looking Back on the millennium in medicine. N Engl J Med 2000; 342: pp. 42-49. [editorial]
2. van Beek E.J., Malone D.E.: Evidence-based practice in radiology education: why and how should we teach it?. Radiology 2007; 243: pp. 633-640.
3. ACGME Program Requirements for Graduate Medical Education in Diagnostic Radiology. 2008. Available at: http://www.acgme.org/acWebsite/RRC-420/420-prIndex.asp . Accessed January 15, 2009.
4. Carlos R.C., Goeree R.: Introduction: health technology assessment in diagnostic imaging. J Am Coll Radiol 2009; 6: pp. 297-298.
5. Hollingworth W., Jarvik J.G.: Technology assessment in radiology: putting the evidence in evidence-based radiology. Radiology 2007; 244: pp. 31-38.
6. Medina L.S., Blackmore C.C.: Evidence-based radiology: review and dissemination. Radiology 2007; 244: pp. 331-336.
7. Dodd J.D.: Evidence-based practice in radiology: steps 3 and 4—appraise and apply diagnostic radiology literature. Radiology 2007; 242: pp. 342-354.
8. Halligan S., Altman D.G.: Evidence-based practice in radiology: steps 3 and 4—appraise and apply systematic reviews and meta-analyses. Radiology 2007; 243: pp. 13-27.
9. Maher M.M., Hodnett P.A., Kalra M.K.: Evidence-based practice in radiology: steps 3 and 4—appraise and apply interventional radiology literature. Radiology 2007; 242: pp. 658-670.
10. Malone D.E.: Evidence-based practice in radiology: an introduction to the series. Radiology 2007; 242: pp. 12-14.
11. Malone D.E., Staunton M.: Evidence-based practice in radiology: step 5 (evaluate)—caveats and common questions. Radiology 2007; 243: pp. 319-328.
12. Staunton M.: Evidence-based radiology: steps 1 and 2—asking answerable questions and searching for evidence. Radiology 2007; 242: pp. 23-31.
13. Phillips R.S., Glasziou P.: What makes evidence-based journal clubs succeed?. ACP J Club 2004; 140: pp. A11-A12.
14. Medina L.S., Blackmore C.C., Hillman B.J.: Evidence-based imaging: optimizing imaging in patient care.2006.SpringerNew York
15. Sheehan J.J., Ridge C.A., Ward E.V., et. al.: FDG PET in preoperative assessment of colorectal liver metastases combining “evidence-based practice” and “technology assessment” methods to develop departmental imaging protocols: should FDG PET be routinely used in the preoperative assessment of patients with colorectal liver metastases?. Acad Radiol 2007; 14: pp. 389-397.
16. Mackenzie R., Dixon A.K.: Measuring the effects of imaging: an evaluative framework. Clin Radiol 1995; 50: pp. 513-518.
17. MacMahon H., Austin J.H., Gamsu G., et. al.: Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005; 237: pp. 395-400.
18. Sheehan J.J., Ridge C.A., Ward E.V., et. al.: The process of evidence-based practice in radiology: an introduction. Acad Radiol 2007; 14: pp. 385-388.
19. Blackmore C.C., Medina L.S.: Evidence-based radiology and the ACR Appropriateness Criteria. J Am Coll Radiol 2006; 3: pp. 505-509.
20. Blackmore C.C.: Critically assessing the radiology literature. Acad Radiol 2004; 11: pp. 134-140.
21. Carlos R.: Introduction to cost-effectiveness analysis in radiology: principles and practical application. Acad Radiol 2004; 11: pp. 141-148.