Improving clinical histories on radiology requisitions.

PURPOSE: The Health Care Financing Administration (HCFA) regards billing for radiologic examinations without an appropriate indication as unlawful, and both the referring physician and the radiologist are liable. HCFA regulations are interpreted as requiring that all requisitions for radiologic examinations include a current diagnosis and appropriate indication for the study. The purpose of this investigation was to determine the rates at which requisitions currently meet these criteria and to assess the effectiveness of a simple intervention designed to improve them. MATERIALS AND METHODS: One hundred fifty consecutive chest radiography requisitions were examined to determine the rate at which current diagnoses and appropriate indications were present. An intervention was then implemented that included a month-long effort to inform referring physicians and radiologists of HCFA regulations, followed by a 1-week period during which requested examinations were not performed unless accompanied by a clinical diagnosis and appropriate indication. Another 150 consecutive chest radiography requisitions were then assessed to determine the effect of the intervention. A 3-month follow-up sample of a third set of 150 consecutive requisitions was then obtained. RESULTS: The intervention produced a 69% decrease in the rate at which current diagnoses were missing from requisitions, and a 61% decrease in the corresponding rate for appropriate indications. Both results are significant with chi2 analysis at the P = .001 level. After 3 months with no additional intervention, rates decayed back toward baseline, with only a 35% remaining decrease for current diagnosis and an 18% decrease for appropriate indication. CONCLUSION: The intervention performed in this study significantly reduces the rate of noncompliance with HCFA regulations. However, this improvement decays over time if it is not reinforced.

The value of good medical student teaching: increasing the number of radiology residency applicants.

RATIONALE AND OBJECTIVES: The authors attempted to define the value of good medical student teaching to the profession of radiology by examining the effect of radiology course improvements on the number of 4th-year students applying to radiology residencies. MATERIALS AND METHODS: Course evaluation and residency application data were obtained from six consecutive classes of 4th-year medical students at the study institution, and these data were compared with national data. RESULTS: Between 1995 and 2000, the number of 4th-year U.S. medical students applying to radiology increased 1.6 times. At the study institution, that number increased 4.5 times, a statistically significant difference (P = .020, chi2 test). Student survey data indicate that this increase reflects a general increase in the quality of radiology teaching in the study institution and specific changes in a required 2nd-year medical school course. CONCLUSION: These results strongly suggest that good medical student teaching pays important dividends, not only to the departments that provide it but also to the profession of radiology as a whole. Exposing students to good radiology teaching early in their medical school careers is especially important. Radiology departments that provide outstanding medical student education should be studied to help develop a model of educational best practices.

Are NBME examination scores useful in selecting radiology residency candidates?

RATIONALE AND OBJECTIVES: The quality of the graduates of radiology residency programs is powerfully affected by the quality of the candidates admitted to them, making the evaluation and ranking of residency applicants one of the most important tasks of radiology education. In the applicant evaluation process, evaluators frequently take into account applicants' scores on the National Board of Medical Examiners (NBME) examination, operating on the implicit assumption that these scores help predict future performance as residents. The purpose of this study was to test that assumption. MATERIALS AND METHODS: Using a data set consisting of information about 99 residents admitted over a period of 10 residency class years, the authors compared scores for parts I and II of the NBME examination with later results on the American Board of Radiology (ABR) written and oral examinations. Logistic regression was used to model differences in resident performance on the NBME and ABR examinations and to determine whether variance in ABR results could be predicted by variance in NBME examination scores. RESULTS: The authors were unable to demonstrate any statistically significant value of NBME examination scores in predicting eventual performance on the ABR written and oral examinations. CONCLUSION: The authors' attempt to validate the widespread practice of using NBME examination scores to evaluate and rank applicants to radiology residency programs demonstrated no discernible value for these scores in predicting the success of residents on the ABR examinations.

Psychosocial issues in pediatric oncology: what the radiologist needs to know.

Pediatric cancer is rife with psychological and social issues for both patients and families. As many of these issues lie outside the traditional bounds of radiological training, many radiology department staff members may be unaware of them, and patient care may suffer as a result. On the other hand, if the radiology staff possesses some understanding of what it means to be or have a child with cancer, they may significantly enhance the family's health-care experience and enrich their own sense of professional satisfaction. This article reviews a number of the key psychosocial issues in pediatric oncology, with a view to improving the non-radiological aspects of radiology patient care.

The outcome of medical outcomes assessment: it's not necessarily academic.

The outcomes assessment movement has the potential to significantly enhance the practice of medicine by enabling physicians to identify and implement what works. It represents a rich wellspring of material for investigation and is already proving to be an important source of research support. As such, it also represents a boon to academic medicine, whose activities in patient care, research, and education it may enrich. Yet outcomes research may also prove itself a threat to academic medicine insofar as the "outcomes" of the academic medical center are not adequately represented in its deliberations and recommendations. Ultimately, the results of the outcomes movement will be defined--both now and in the generation to come--by medicine's guiding vision. It behooves those who care about academic medicine to recall that this vision itself is a highly prized outcome.