RSNA News - August 2005

Video Replay Helps Radiology Residents Improve Performance

Almost universally, all the residents expressed a new feeling of comfort when they were presenting.
— Jeffrey Chankowsky, M.D.

“Let’s go to the videotape.” Sports fans hear those words when there is exciting, controversial or important action on the field or in the

Resident Christopher Sidden M.D. (left), sits in the "hot seat" at McGill University. He's surrounded by fellow students and academic and research supervisor Benoit Mesurolle, M.D. (seated, right).

stadium. Thanks to technology, replay is available within seconds after a play is completed.

That ability for instant analysis provides fodder for a unique new study in the field of radiology education that’s drawing attention from around the world. During a recent six-week experiment called “ACTION!”, six radiology residents at McGill University Hospital Center in Montreal were videotaped while discussing cases at teaching rounds.

The residents’ performances were reviewed and critiqued by an academic radiology “coach,” Jeffrey Chankowsky, M.D., and then the residents were taped a second time to see if they improved. At the end of the six weeks, the residents’ communication skills ranked higher as did their case-based knowledge.

The experiment was the brainchild of Marie-Therese Nguyen, M.D., who was a second-year radiology resident when the experiment started. “At the time, I was taking some tennis and ski lessons. My coach said, "Let me videotape you to see if we can improve your serve or slalom". So we did that and I had videotaped feedback and I thought, "Why don’t we use this in radiology?" In radiology you have to have knowledge within the content but you also have to have presentation skills,” she explained.

Dr. Chankowsky, an assistant professor of radiology at McGill University, said he was intrigued with the idea as it applied to medical education. “We used a digital video camera from the audio-visual department, set it up on a tripod and put it on one side of the room during formal radiology rounds at one institution,” he explained.

During those rounds, residents were assigned random medical cases. The residents were asked to present, give a diagnosis and a plan of action in an examination format. The academic staff members then provided feedback. “We videotaped everybody at each session. We showed the tapes to the teacher, the residents and two independent, non-involved radiologists,” said Dr. Chankowsky. “By the end of the taping sessions, each of the participants was judged on six, 10-minute sessions.”

Because there was so little information in the academic literature on radiological examination criteria, Dr. Nguyen developed a survey of her own and worked with a statistician to create a scoring system. “There were criteria from different categories, such as knowledge (content) versus style (communication skills),” she said. “For each criterion, I asked, ‘how important do you think this is in evaluating case discussion?’ We then put that data in a graph to see which criteria were more important than the other.”

Christopher Sidden, M.D., a fifth-year resident at McGill University, was one of the study participants. He has also used videotape to improve

Resident Marie-Therese Nguyen M.D., stands in front of an exhibit of early x-ray tubes on display at Royal Victoria Hospital. Academic and research supervisor Benoit Mesurolle, M.D., works in the reading room at the Cedar Breast Imaging Center at Royal Victoria Hospital.

performance while swimming competitively in high school and college, but it was the first time he’d been videotaped during rounds. “The biggest thing is that you think you’re being very clear. In your head it all is very clear, but then you see you’re not as clear as you thought you were,” he said. “I sounded disjointed and more disorganized than I thought I was.”

Following the first session of videotaping (pre-feedback), residents met one-on-one with Dr. Chankowsky to see themselves and get feedback. Dr. Sidden said the meetings prompted some changes. “I obviously improved,” he said laughing. “I’m glad we did this, otherwise I don’t know how long it would have taken me to realize I needed improvement.”

Dr. Nguyen admits one of the biggest benefits to the video feedback may be simply in helping residents overcome testing anxiety for board examinations. “When you take your boards, you sit in the hot seat and you’re presented an unknown case. You have to put everything together and discuss it. To be exposed to that early on in a mock situation should reduce your anxiety for the real exam. For the residents, it seems to help them feel more confident when they take cases,” she said.

After the feedback with Dr. Chankowsky, the young radiologists had a chance to tune up before being taped in a subsequent session of formal rounds.

Two independent academic radiologists then reviewed both sets of tapes in random order without knowing which were from the first round and which were from the second round. The analysis showed a positive shift in performance.

“Almost universally, all the residents expressed a new feeling of comfort when they were presenting,” he said. “They were provided with good tips to organize themselves and present properly.”

Dr. Nguyen said her research found many instances where videotaped feedback is used in other medical specialties including psychiatry, family medicine and surgery. But because she could not find examples of video used in teaching radiology she was unsure what her results would reveal. Now she believes it would be beneficial for institutions to consider turning the cameras on residents in an effort to make their communication more meaningful. “Every word is important in radiology,” explained Dr. Nguyen. “In fact radiology is the science and art of describing—of conveying what you see. In order for a radiologist to be a useful and credible consultant you have to have a fairly consistent, clear and uniform way of describing so that people can recognize what you say.”

The McGill University radiologists involved in the project don’t know if they will find the time or funding to continue the video program, but they are making note of the idea’s popularity. “This one research project has been discussed at nine major meetings,” said Dr. Chankowsky. “Dr. Nguyen has been invited across the world. Few people do radiology education research, so she really fell into an interesting area.”

Dr. Nguyen and/or her colleagues presented the “ACTION!” program at meetings for organizations including the American Roentgen Ray Society, Association of University Radiologists, and Association for the Study of Medical Education.