P. McCoubrie

Radiology curriculum for undergraduate medical studies--a consensus survey.

AIM To establish an expert consensus of what, when, and how the teaching of radiology should be incorporated into the core undergraduate medical curriculum. METHODS AND MATERIALS This Delphi survey consisted of four iterative rounds, with feedback given at the start of each successive round in the form of the results of the previous round. The participants consisted of both radiologists and non-radiologists with significant interest and involvement in radiology and undergraduate/Foundation training. The study addressed the questions of how, where, when, and by whom radiology should be taught. RESULTS The number of responses in rounds 1-4 was 20, 23, 41, and 25 (25, 22, 31, and 61% response rate, respectively). There was good consensus amongst the responders on the following: radiology teaching must be delivered in conjunction with anatomy and clinical case-based teaching, if possible in the department of radiology on picture archiving and communication system (PACS) workstations, and the teaching should be delivered by a competent and credentialled individual. Case-based assessment was the most agreed method of assessment. The majority of the responders concurred that the curriculum should include general indications for commonly requested radiological investigations, consent and safety issues around radiological tests, and their basic interpretation. CONCLUSION The consensus points reached by the present study not only serve as directive principles for developing a more comprehensive radiology curriculum, but also places emphasis on a broader range of knowledge required to promote the best use of a department of radiology by junior doctors in an attempt to improve patient experiences and care.

Single best answer MCQs: a new format for the FRCR part 2a exam

The single best answer multiple-choice question (MCQ) format has many advantages over traditional true/false format MCQs. From 2009, the Royal College of Radiologists will be adopting this format for written examinations. This article describes the background of this decision and the evidence behind it. There are numerous benefits to examiners and candidates alike from adopting this format. Using examples, the usual structure of the format of this type of questions is explained, how they are written, and tips provided on how to prepare for and answer them.

The Bristol Radiology Report Assessment Tool (BRRAT): Developing a workplace-based assessment tool for radiology reporting skills

AIM To review the development of a workplace-based assessment tool to assess the quality of written radiology reports and assess its reliability, feasibility, and validity. MATERIALS AND METHODS A comprehensive literature review and rigorous Delphi study enabled the development of the Bristol Radiology Report Assessment Tool (BRRAT), which consists of 19 questions and a global assessment score. Three assessors applied the assessment tool to 240 radiology reports provided by 24 radiology trainees. RESULTS The reliability coefficient for the 19 questions was 0.79 and the equivalent coefficient for the global assessment scores was 0.67. Generalizability coefficients demonstrate that higher numbers of assessors and assessments are needed to reach acceptable levels of reliability for summative assessments due to assessor subjectivity. CONCLUSION The study methodology gives good validity and strong foundation in best-practice. The assessment tool developed for radiology reporting is reliable and most suited to formative assessments.

The FRCR 2B oral examination: Is it reliable?

AIM To investigate the reliability of the oral component of the Fellowship of the Royal College of Radiologists (FRCR) 2B examination. MATERIALS AND METHODS Anonymized candidate test scores were analysed from nine consecutive sittings of the FRCR 2B oral examination covering the period from spring 2006 to spring 2010. Interobserver reliability was assessed using weighted Kappa coefficient, intraclass correlation coefficient, and a modified Bland-Altman plot. RESULTS During the study period, 2235 candidates sat the FRCR 2B examination. Eighty-five point one percent of candidates obtained paired oral assessment scores within one mark of each other. This figure rises to 95.7% for paired scores within 1.5 marks of each other. Mean difference in scores was 0.67 (95% CI: 0.65-0.70). Agreement rises at the extremities of mean score. Reliability coefficients for the FRCR 2B oral examination were calculated as 0.27 (weighted Kappa) and 0.44 (intraclass correlation coefficient). CONCLUSION The calculated reliability coefficients indicate fair to, at best, moderate interobserver reliability in the FRCR 2B oral examination. These findings are disappointing but are comparable with other oral assessment reliability studies. There is scope for improvement, although further work to measure the combined reliability of all the components of the FRCR 2B examination is desirable. Measures that could potentially increase reliability must be carefully considered against any negative impact on test validity, acceptability, and cost.

The FRCR 2B examination: a survey of candidate perceptions and experiences

AIM To survey the views of recent candidates of the Fellowship of the Royal College of Radiologists (FRCR) 2B examination with reference to assessment validity, reliability, and acceptability. MATERIALS AND METHODS One thousand, two hundred and four UK radiology trainees and consultants were invited to complete an automated internet questionnaire regarding their experiences and perceptions of the FRCR 2B examination. The questionnaire was informed by a review of the literature. Eligible participants were candidates who had taken the examination within the previous 3 years. RESULTS Four hundred and ninety-seven out of 1204 (41%) responses were received; of which 258/497 (52% of respondents) were eligible for inclusion into the study. The rapid reporting component is perceived to be significantly fairer than the oral section (82 versus 70% agree; p<0.001). The oral component fared poorly in perceived performance-reducing anxiety levels but well in questions relating to validity and reliability. Female candidates are more likely to find the FRCR 2B unfair (p=0.01) and experience performance-reducing anxiety (p<0.001) than males. No gender differences were observed in first-time pass rates (p=0.6). Candidate first language did not affect anxiety levels (p=0.9) or first-time pass rates (p=0.06). Only 12% of candidates agreed that the oral examination should move to an objective structured clinical format. CONCLUSION Candidates score the FRCR 2B examination well in test validity with little desire for change to the oral examination format. Efforts to help reduce anxiety levels in the oral component would improve perceived fairness.

Re: The FRCR 2B oral examination: Is it reliable? A reply

Sir d We read with interest the article by Yeung et al.1 highlighting the limitations in the reliability of the oral component of the FRCR 2B examination. During the assessment of the candidate, two individual assessors score the candidate for each of the films that they see using set criteria for scoring as defined by the RCR.2 The pair of assessors then agree to the final score for that particular viva following a discussion of the overall performance; this happens immediately after the viva. We believe that a candidate’s score close to the pass mark is again discussed at the examiners’ meeting to confirm that it is representative of the overall performance. These processes actually add another layer to the reliability of the scoring system. Examiners are paired together based on their level of examining experience, thereby reducing variability in their scoring due to a lack of experience. Furthermore, both examiners have different subspecialty expertise, which should allow the scoring to remain more consistent throughout the exam. We believe the variability in scores of the separate vivas is not unexpected. The main reason is that the films in each exam are different, covering varying modular areas, which identify potential candidateweaknesses. Due to the breadth of the radiology curriculum, it is unreasonable to assume that a candidate will perform in a constant way over two vivas. Moreover, candidates can sit the exam at any stage after 3 years of full-time training and will have developed areas of strengths and weaknesses depending on their clinical experiences and subspecialty interests. This could also go some way to explain the variation between scores. Stress andnervousness at the start of the exam followedby potential fatigue as the examprogresses could contribute to a candidate’s scores over the two vivas. This is certainly our experience having recently sat the exams ourselves. Your results have shown 85.1% of candidates have a difference of less than one mark between the scores over the two vivas. We feel this actually demonstrates consistency in

Reducing interruptions during duty radiology shifts, assessment of its benefits and review of factors affecting the radiology working environment

AIM To investigate and reduce the number of inappropriate interruptions to the duty radiology registrar, as well as subjectively assess the effect of reducing interruptions and identify other methods of improving the duty working environment. MATERIALS AND METHODS A pre- and post-intervention prospective quantitative study and post-intervention retrospective qualitative study of duty radiology registrars was performed at a tertiary referral centre. The first cycle of the quantitative study was performed prior to implementation of a telephone triage system. The second cycle and qualitative study were performed afterwards. RESULTS The average number of interruptions per day dropped by 43.7% after the intervention. Moreover, inappropriate interruptions dropped from one in three to one in five interruptions. Improvement was demonstrated following the intervention for perceived patient safety, workload, reporting efficiency, reporting accuracy, work satisfaction, and stress. The most common hindrance to a good working environment was interruptions (36%). The most common suggestion for improvement was improved comfort (33%). CONCLUSION The present study demonstrates that a telephone triage system can substantially reduce the number of interruptions to the duty radiologist. It also demonstrates that reducing interruptions in radiology has the potential to improve the working environment in many ways.

Quality not expediency

palliative care unit (Gishen & Trotman 2009). We agree that ultrasound can be an extremely useful investigation in palliative care patients. Its non-invasive, painless nature and the dynamic nature of scanning make it appropriate for all the purposes suggested in this paper. However, we would like to draw your attention to a number of points. First, there is no mention made to the recommendations made by the Royal College of Radiologists for Training in Ultrasound for the Medical and Surgical Specialties (Royal College of Radiologists 2005). These widely accepted guidelines are aimed to ensure high quality imaging services (or ‘best practice’) and support the minimal training requirements proposed by the European Federations of Societies for Ultrasound in Medicine and Biology. For the needs of the service suggested in the article, Level 1 training would be required – equivalent to a radiology registrar after 3 or 4 years of training. This level of training includes (for example) a knowledge of the physics underlying the technology of ultrasound so that artefacts can be differentiated from pathology. Ongoing training and clinical supervision by Level 2 or 3 standard practitioners is also necessary. Sufficient number of scans need to be performed – 40 scans in a 17-month period is arguably insufficient to maintain competence. Second, simply buying an ultrasound machine and ensuring its safety is inadequate. Some form of regular Quality Assurance, such as a service contract, is needed to ensure the machine can still produce diagnostic quality scans. No form of Quality Assurance is mentioned in the paper. This would increase the apparently cheap scan cost. On this point, we would like to make a recalculation. The discussion implies that many of these scans were simply done due to the easy availability of the scan. Removing the scans relating to paracentesis the cost per scan increases to almost £40, excluding all ongoing expenses. While we support the availability of easily accessible ultrasound services, particularly in the palliative care setting, quality must be paramount over expediency. Scans should only be performed by suitably trained individuals with an established clinical support structure. Such individuals should only use appropriate machines which are regularly maintained to ensure adequate scan quality. While such services are often most easily provided by a hospital-based clinical radiology department, this may not be most practical in a hospice remotely sited from the nearest hospital. With the advent of portable ultrasound machines, a peripatetic community-based ultrasound service is perfectly feasible. Indeed, in north Bristol, such a service providing GP surgeries with deep venous thrombosis ultrasound has been commissioned. We summarise by arguing that it would be a better use of resources to employ a professional peripatetic service than to mimic the service described in the paper by Gishen and Trotman (2009).