Mega-conference: A Radical Approach to Radiology Resident Education with Full-day Weekly Conferences Hannah Rapaport MD, Judyta Loomis MD, Nolan J Kagetsu MD, Munir Ghesani MD, Gloria Jorge C-TAGME, Michael M Abiri MD, James E Silberzweig MD Department  of  Radiology,  Beth  Israel  Medical  Center,  New  York,  NY,  St.  Luke’s-Roosevelt Hospital, New York, NY

Introduction

Results

There is one Department of Radiology for the Continuum Health Partners system, which includes two separate ACGME-accredited residencies  at  Beth  Israel  Medical  Center  (BIMC)  and  St.  Luke’sRoosevelt Hospital (SLR). Each program trains an average of 24 residents. The two residencies undertook a radical approach to conference-based resident education by combining in one location for a weekly all day joint conference. Seven 1-hour conferences were scheduled per conference day. This was a change from the more typical two lectures per day, some of which were teleconferenced or duplicated between sites. Tardiness, cancellations and interruptions to both the clinical day and the conference hour were relatively frequent and detracted from the resident learning experience.

Discussion

Responders / Surveyed (percent of response)

31/ 49 (63.3%)

Learning radiology

More efficient 9/29 (31.0%)

Comparable 14/29 (48.3%)

Less efficient 6/29 (20.7%)

Less efficient 6/29 (20.7%)

Resident study preparation for conference

Significantly more 2/30 (6.7%)

Somewhat more 6/30 (20.0%)

Comparable 17/30 (56.7%)

Less 5/30 (16.7%)

Resident participation on rotations

Increased 8/30 (26.7%)

Same 17/30 (56.7%)

Decreased 5/30 (16.7%)

Decreased 5/30 (16.7%)

Overall impression of Megaconference

Positive 9/30 (30.0%)

Neutral 16/30 (53.3%)

Negative 5/30 (16.7%)

Negative 5/30 (16.7%)

Table 3. Resident survey responses from the 6 month survey. Pro: •The overall quality of the conferences has improved. The curriculum is better coordinated within sections. •I especially enjoyed first year directed lectures.

Methods

•More consolidated learning, better quality of lectures.

Residents were anonymously surveyed at 1, 6, and 12 months. Faculty members were anonymously surveyed at 12 months. Resident dictation volume was tabulated for both BIMC and SLR, in addition to total institutional volume for the academic year before and after the format change. Written board exam results were collected over four years, including one year after the change. 2008

2009

2010

2011

Mean score (± sd)

2.55 (± 0.935)

2.57 (± 1.104)

2.30 (± 1.005)

2.43 (± 1.078)

n

10

13

11

15

Table 1. Written board results. 2011 is the only test year following the change in format. Academic year

2009-2010

2010-2011

Change

Resident dictation volume

181,005

186,629

3.10%

Total institutional volume

588,975

486,049

-17.50%

Table 2. Dictation volume before (2009-2010) and after (2010-2011) the format change.

Con: •For oral board prep, having two conferences daily offers more case volume with more chance for feedback. •I feel that this format leads to a more distanced, less interactive learning environment for the residents. •It’s  difficult  to  prepare  for  the  weekly  conferences  when  there  are  so  many  subjects  presented. •Total hours per week of conference have decreased. Table 4. Write-in responses from 6 month anonymous resident survey

The new format resolved conflicts of time as the residents no longer have to leave rotations during the day. Timeliness and attendance improved for both residents and faculty. Program director supervision of the conference day helps the day run smoothly, arranging replacements for any last-minute cancellations. Faculty members are incentivized to prepare more extensively for the new larger audience, while residents expect a higher yield of each conferences. With better planning of the full year curriculum, allocation of topics has been more closely scrutinized, which in turn has reduced the need for outside speakers. Fewer residents are able to take cases at the case-based conferences, a change which is aligned with the upcoming de-emphasis on oral board exam style preparation. Side conferences allow for level specific training - for instance, call preparation for first years or board review for seniors. Faculty members cover all clinical services on the conference day without the help of residents. While this has increased faculty workload, it has required only minimal adjustments to the patient exam schedule. Residents on evening/overnight call or on Interventional Radiology do not attend conference that week. Data collected on resident dictation volume and written board scores before and after the change in format showed no significant detriment to resident achievement (tables 1 and 2). Survey results are sampled in tables 3 and 4.

Conclusion The weekly conference model has proved to have both advantages and drawbacks for our residency programs. While most residents are comfortable with the new format, some residents continue to prefer frequent daily conferences, most attributable to individual attention span and learning style. The Mega-conference remains a work-in-progress, and we continue to work to improve the educational experience for residents amidst global changes to the board examinations. Our goal in the transition to a weekly full-day conference format was to improve education within the BIMC/SLR residency programs, which combined, is comparable in size to a large radiology residency program. Many training programs face similar challenges in providing a comprehensive and rigorous conference curriculum. This format may be suitable for programs that rely on teleconferencing between sites or for multiple small programs wishing to unite for academic purposes.