Radiologists have often been referred to as the “doctor’s doctor” because of their role as consultants. They frequently serve as the decision point in diagnosis, driving the future steps of a patient’s healthcare process. While this consultative post tends to make the specialty appealing, being so critical to the care process can also cause anxiety, especially for new radiology residents.
Radiology curricula do not typically cover how to interact with and advise other physicians and patients, nor do they encompass how to guide appropriate image ordering. Incoming residents are often so focused on the clinical aspects of interpreting images and creating reports, their role as consultants is frequently overlooked. This can lead to downstream challenges, given that radiologists are frequently the first points of contact for referring providers and patients.
The beginning of residency is usually the first time residents serve in this advisory role. Without much experience, residents are more likely to take actions that could potentially subject patients to unnecessary radiation exposure and additional costs. Improving resident education about appropriate imaging early in their training can lead to better quality care, and attending radiologists have a part to play in this important education.
At Baylor College of Medicine in Houston, radiologists have embraced this duty, creating an educational module to teach residents how to provide quality consultations and deliver patient-centered care. In doing so, the module leverages a web-based program called Radiology-TEACHES , an educational tool that uses an ACR hosting platform to deliver case vignettes covering a variety of scenarios, from providing consultation to ordering providers and patients to understanding the costs of unnecessary imaging.
Combined with an interactive session with a patient volunteer, the module gives emerging radiologists new insights into how radiologists can put patients at the center of care. “There are many opportunities for radiologists to advocate for patients throughout the cycle of imaging,” says Karla A. Sepulveda, MD, associate professor of radiology at Baylor. “For example, radiologists can help ensure convenient scheduling, along with safe and appropriate imaging. They can also discuss imaging results directly with patients, coordinate care with physician partners, and produce patient-friendly reports with clear recommendations for any needed follow-up. We highlight these opportunities throughout the module.”
The following Monday, Sepulveda and the residents met again to discuss the cases and their imaging recommendations. Sepulveda also reviewed several residents’ answers to the open-ended consultation questions with the group, opening a conversation about what residents should do in such situations. The remainder of the session involved a patient coming to speak with the residents.
Sepulveda invites patients to speak during different sessions and says patient Melissa Sutter’s testimonial was especially powerful. “Melissa is a colleague of mine who is also a researcher. She’s young and has children and was diagnosed with advanced stage breast cancer,” Sepulveda explains. “I think having someone who was very close to where the residents were in their lives helped increase the relatability: This could have been them.”
For her part, Sutter says she agreed to participate in the conference to help the residents better relate to their patients. “If you’re only seeing the patient’s imaging study, it might be difficult to relate to the patient after 50 cases a day,” she says. “It’s important to have a reminder of the story behind the scan and to remember that your work has a direct impact on the lives of the people in the scans.”
Sutter shared her story with the residents and emphasized that receiving results quickly was important to her as a patient. “I think I surprised them most when I told them I’d rather receive bad news over the phone instead of in person, if it meant I’d receive my results faster,” she says. “When you receive bad news, you need time to process and to research your diagnosis so you can ask informed questions. Receiving this news in person doesn’t give you the time to do that, and so the appointment feels wasted to me.”
For Nikita Consul, MD, a resident who completed the module, the patient testimony helped give her work context. “Hearing the patient’s perspective is the only way to know what kind of impact our work has on patient care. It reminds me what a radiologist’s primary motivation is, and why we do our job. We are in a service-oriented profession, and we owe it to radiology to hear the perspective of our patients.”
Following the patient testimony, the residents completed a survey in which they rated their comfort level with consulting on imaging appropriateness, safety, and cost before and after the module. The rating scale ranged from one to seven, with one being “somewhat comfortable” and seven being “very comfortable.” All residents reported a higher level of comfort with
imaging appropriateness consultation after completing the module, and nearly all residents recommended that the module be included in the introductory curriculum for residents.
Consul says her favorite part of the module was the emphasis it put on the radiologist as the clinical decision support consultant. “It inspired me to take on the responsibility of educating my colleagues in clinical residency programs who may call me with questions. I also enjoyed the patient’s firsthand perspective on their interactions with radiologists; it provided me with great insight about how I may want my future practice to be as a radiology attending,” she adds.
Based on such positive feedback, Sepulveda and Willis plan to continue sharing this module with first-year residents and to extend the module beyond Baylor College of Medicine. They are also working to develop additional shareable patient-centered tools and resources among academic radiology programs at other institutions.
Although many patient-centered care tools exist, Willis says that this module goes even farther in terms of cost, safety, and concepts of high-value care. “We would like to create resources for residencies across the United States and internationally to integrate into their training of future radiologists. The curriculum fills current gaps in residency education emphasizing the impact evidence-based radiology consultation has in providing high-value patient-centered care,” he says.
Radiology-TEACHES recently completed the beta phase of development, and the ACR is making the cases freely available to institutions that join the Radiology-TEACHES community. While not everyone has the ability to customize cases in Radiology-TEACHES, Sepulveda believes that the intent behind the consultation module — educating residents about their role in imaging appropriateness and patient-centered care — is entirely reproducible, as long as educators start with simple steps.
“The most important part is educating future radiologists about cost, quality care, and the patient behind the image,” she says, adding that radiologists can incorporate these concepts into any case reviews. “As you go through the case, bring up the consulting component. Ask your residents, ‘If the ordering physician comes in and wants to discuss this case, what things might you say to them? How would you advise them on what the most appropriate imaging is?’”
Incorporating the patient voice can help solidify the concepts. Sepulveda notes that patients, especially those who work at the hospital or are member’s of the institution’s patient advisory council, are usually willing to speak to residents. It’s simply a matter of reaching out to them, explaining your goal, and scheduling a time.
Patient testimonials are a powerful way to tie everything together and remind residents about the impact of their work, Sepulveda says. “After the patient has presented, everyone tends to feel emotional. From there, I’ll open up the conversation to discuss the residents’ personal experiences as radiology patients, whether their firsthand experiences or their experiences with family members. This interaction brings it home — and helps everyone empathize, putting them on a path for more patient-centered care.”
Meghan Edwards is a freelance writer