LI-RADS in the year 2020 - Are you already using it or still considering? / LI-RADS im Jahr 2020 ­ Nutzt du es schon oder überlegst du noch?

PURPOSE: The working group for gastrointestinal and abdominal imaging within the German Radiological Society performed a nationwide online survey in order to assess the current status regarding the awareness and application of LI-RADS, a classification for evaluation of liver lesions in patients at risk. MATERIALS AND METHODS: Using the website www.deutsches-krankenhausverzeichnis.de a list of hospitals was generated meeting the criteria internal medicine, gastroenterology, general and visceral surgery and radiology (n = 391). Randomly, 102 department directors were contacted, and asked to name one consultant and one resident from their department in order to participate in the survey. 177 potential participants were invited to fill out an approximately 10-minute online survey in the form of 17 questions regarding the awareness and application of LI-RADS. The results of the survey were analyzed by means of descriptive statistics. RESULTS: 77 participants were registered, which corresponds to a response rate of 43.5 %. 47 % of all participants were radiologists, 30 % surgeons and 23 % internal doctors/gastroenterologists, respectively, many with more than 13 years of professional experience (37.2 %). The majority of participants worked in a hospital with a focus (37.2 %) or a university hospital (29.1 %). Even though the majority of participants knows about or has heard of LI-RADS (73.2 %), only a minority uses the classification themselves (26 %) or within the context of tumor boards (19.2 %). CONCLUSION: The results of our survey demonstrate that LI-RADS is relatively known in Germany, the application however quite sparse. This is in contrast to the general desire and endeavor for more standardized reporting in radiology. KEY POINTS: · LI-RADS is not yet broadly implemented in clinical routine in Germany. · The sparse application is in contrast to the general desire for more standardized reporting in radiology. · Interdisciplinary education may support the propagation and use of the LI-RDAS classification. CITATION FORMAT: · Ringe KI, Gut A, Grenacher L et al. LI-RADS in the year 2020 - Are you already using it or still considering? Fortschr Röntgenstr 2021; 193: 186 - 193.

Impact of postgraduate training on communication skills teaching: a controlled study.

BACKGROUND: Observation of performance followed by feedback is the key to good teaching of communication skills in clinical practice. The fact that it occurs rarely is probably due to clinical supervisors' perceived lack of competence to identify communication skills and give effective feedback. We evaluated the impact of a faculty development programme on communication skills teaching on clinical supervisors' ability to identify residents' good and poor communication skills and to discuss them interactively during feedback. METHODS: We conducted a pre-post controlled study in which clinical supervisors took part to a faculty development program on teaching communication skills in clinical practice. Outcome measures were the number and type of residents' communication skills identified by supervisors in three videotaped simulated resident-patient encounters and the number and type of communication skills discussed interactively with residents during three feedback sessions. RESULTS: 48 clinical supervisors (28 intervention group; 20 control group) participated. After the intervention, the number and type of communication skills identified did not differ between both groups. There was substantial heterogeneity in the number and type of communication skills identified. However, trained participants engaged in interactive discussions with residents on a significantly higher number of communication items (effect sizes 0.53 to 1.77); communication skills items discussed interactively included both structural and patient-centered elements that were considered important to be observed by expert teachers. CONCLUSIONS: The faculty development programme did not increase the number of communication skills recognised by supervisors but was effective in increasing the number of communication issues discussed interactively in feedback sessions. Further research should explore the respective impact of accurate identification of communication skills and effective teaching skills on achieving more effective communication skills teaching in clinical practice.

Acquisition of clinical competence: Added value of clerkship real-life contextual experience.

BACKGROUND: Medical students' limited access to patients induces a shift of learning activities from clinical wards to classrooms. AIM: Identify clinical competencies specifically acquired during real-life contextual clerkship added to case-based tutorials, by a prospective, controlled study. METHODS: Students entering our eight-week internal medicine (IM) clerkship attended paper case-based tutorials about 10 common presenting complaints and were assigned to an IM specialty ward. For each tutorial case, two groups of students were created: those assigned to a ward, the specialty of which was unrelated to the case (case-unrelated ward, CUW) and those assigned to a ward, the specialty of which was related to the case (case-related ward, CRW). RESULTS: Forty-one students (30 CUW and 11 CRW) volunteered for the study. Both groups had similar previous experiences and pre-clerkship exam scores. The CRW students collected more relevant clinical information from the patient (69% vs. 55% of expected items, p=0.001) and elaborated charts of better quality (47% vs. 39% of expected items, p=0.05). Clinical-knowledge mean score was similar (70%) in both groups (p=0.92). CONCLUSIONS: While paper-case tutorials did provide students with clinical knowledge, real contextual experience brought additional, specific competencies. This supports the preservation of clinical exposure with supervision and feedback.

Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills.

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents' CS in clinical practice. The authors designed a pretest-posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6-9 months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents' needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents' communication skills was successful in improving clinical supervisors' feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approach.

Bringing explicit insight into cognitive psychology features during clinical reasoning seminars: a prospective, controlled study.

CONTEXT: Facets of reasoning competence influenced by an explicit insight into cognitive psychology features during clinical reasoning seminars have not been specifically explored. OBJECTIVE: This prospective, controlled study, conducted at the University of Geneva Faculty of Medicine, Switzerland, assessed the impact on sixth-year medical students' patient work-up of case-based reasoning seminars, bringing them explicit insight into cognitive aspects of their reasoning. METHODS: Volunteer students registered for our three-month Internal Medicine elective were assigned to one of two training conditions: standard (control) or modified (intervention) case-based reasoning seminars. These seminars start with the patient's presenting complaint and the students must ask the tutor for additional clinical information to progress through case resolution. For this intervention, the tutors made each step explicit to students and encouraged self-reflection on their reasoning processes. At the end of their elective, students' performances were assessed through encounters with two standardized patients and chart write-ups. FINDINGS: Twenty-nine students participated, providing a total of 58 encounters. The overall differences in accuracy of the final diagnosis given to the patient at the end of the encounter (control 63% vs intervention 74%, p = 0.53) and of the final diagnosis mentioned in the patient chart (61% vs 70%, p = 0.58) were not statistically significant. The students in the intervention group significantly more often listed the correct diagnosis among the differential diagnoses in their charts (75% vs 97%, p = 0.02). CONCLUSION: This case-based clinical reasoning seminar intervention, designed to bring students insight into cognitive features of their reasoning, improved aspects of diagnostic competence.

[Suicidal behavior in children]. / Conduites suicidaires chez l'enfant.

Because of the rarity of suicide and attempted suicide in young children the subject is not commonly studied and is quite poorly understood. Indeed, we have longed denied the possibility of a young child's enactment of a suicidal desire. The myth of total childhood innocence paired with societal views on death and mourning make suicide at this age unacceptable and furthermore, unthinkable. Everything is positioned towards denial; however suicidal behaviour does exist in children and we can identify specifics surrounding the methods used, and their meaning in both the social and environmental contexts in which they take place. Within the following we will suggest and provide tools for prevention and treatment.

[Therapeutic education in young patients with schizophrenia]. / Education thérapeutique du jeune patient schizophrène.

There is a specific therapeutic patient education program for young adults suffering from schizophrenic disorders. The aim of this therapeutic education project is the improvement in the treatment of schizophrenic patients as well as continuity of care.

[Bipolar disorders in children and adolescents]. / Trouble bipolaire de l'enfant et de l'adolescent.

While difficult, early detection of bipolar disorders in children and adolescents is crucial. Depending on age, diagnosis may be more or less difficult. Family history and the environment must also be taken into account.

Altered semantic but not phonological verbal fluency in young help-seeking individuals with ultra high risk of psychosis.

Some of the cognitive impairments of schizophrenia are already detectable before the onset of the disease, and could help to identify individuals at higher risk of psychosis. In patients with schizophrenia, semantic verbal fluency (VF) is more impaired than phonological fluency. We investigated whether the same profile is present in young patients at Ultra High Risk of psychosis (UHR). One hundred and fifty six young patients (15-30y.o.) consecutively seeking help at our specialized youth mental health center with no definite psychiatric diagnoses were recruited and assessed with the CAARMS. Individuals meeting the criteria for UHR were compared to the remaining patients considered as Help Seeker Controls (HSCo). UHR individuals had a lower mean total semantic fluency score than HSCo. This effect was significant for each semantic category ('animals' and 'fruits'). By contrast, there were no differences in phonological fluency scores between UHR and HSCo either in the total score or when each letter ('P' and 'R') was considered separately. Semantic but not phonological VF differentiated UHR individuals from non-psychotic help-seeking young adults. These results suggest that semantic deficits are present during the prodromal phase, prior to clinical expression of full-blown psychosis, and suggest that prodromes could be associated with alteration in temporal brain areas.

Brief report: beyond clinical experience: features of data collection and interpretation that contribute to diagnostic accuracy.

BACKGROUND: Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN: Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS: Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS: Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION: Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success.

Live or computerized simulation of clinical encounters: do clinicians work up patient cases differently?

Computer simulation of clinical encounters is increasingly used in clinical settings to train patient work-up. The aim of this prospective, controlled study was to compare the characteristics of data collection and diagnostic exploration of physicians working up cases with a standardized patient and in a computerized simulation. Six clinicians of different clinical experience in internal medicine worked up three cases with a standardized patient and through a computer simulation allowing free inquiry. After each encounter, we asked the subjects to justify the information collected and to comment on their working diagnoses. The characteristics of data collected and working diagnoses generated were assessed and compared, according to the simulation method used. In the computer simulation, physicians limited their data collection and focused earlier and more specifically on information and working diagnoses with high levels of relevance. They reached a similar diagnostic accuracy and made decisions of a similar relevance. Computer simulation with a free-inquiry approach reproduces the data collection and the diagnostic exploration observed in a standardized-patient simulation and promotes an early collection of relevant data. Its contribution to extend the competence of learners in clinical settings should be further evaluated.

Common strategies in clinical data collection displayed by experienced clinician-teachers in internal medicine.

The role model displayed by clinician-teachers influences learning experiences but learners may face various reasoning styles. Our goal was to describe common strategies in clinical data collection displayed by experienced clinician-teachers in internal medicine. We studied six internists heavily involved in teaching while they were working up the same seven cases portrayed by a standardized patient. Each encounter was audio-recorded and replayed to allow the subjects commenting on the purpose and diagnostic hypotheses considered for each piece of information collected. Information and hypotheses elicited by all physicians were considered key items. Although the subjects reached the same final diagnoses, they differed on several characteristics of their data collection process. They also displayed common behaviours, such as: early acquisition of key data (half of them acquired within the first 19 questions asked) through clarification of the patients' complaints and focused data collection; early generation of the final diagnosis (within the first 10 questions asked) and use of diagnostic hypotheses to frame data collection; and summarization of the information at hand during the encounter (at least twice). Whether making teachers explicitly conscious about their own reasoning processes may help them better model and explain their diagnostic approach to specific cases should be assessed in follow-up studies.

Degree of concurrency among experts in data collection and diagnostic hypothesis generation during clinical encounters.

BACKGROUND: Given that there are variations in clinicians' reasoning, methods to elaborate scoring checklists for standardised patient-based assessment need to be valid. The use of data elicited by experts solving problems independently has been advocated as a method of setting performance standards. AIMS: To determine the degree of concurrence and common characteristics among items independently elicited by doctors during patient encounters and to assess the number of experts needed to derive reliable performance standards. METHODS: Six experienced internists worked-up the same 7 chief complaints with standardised patients (SPs). A stimulated recall of the recorded encounter was then performed. The degree of concurrence of the collected history and physical examination information and the generated diagnostic hypotheses was computed. Reliability was derived from generalisability analyses. RESULTS: By case, experts elicited a mean of 114 information items (SD = 15) and generated 30 diagnostic hypotheses (SD = 6). A high concurrence (80-100%) was observed for a mean of 22 information items (20%; SD = 6) and 7 diagnostic hypotheses (24%; SD = 2). More than a third of the 153 highly concurrent information items were clarification questions. At least 3 doctors were needed to obtain a reliability of 0.80 or higher when deriving the scoring checklists. CONCLUSION: The limited concurrency in data elicited by clinicians during a patient encounter supports the use of high-fidelity methods to develop performance checklists used in SP-based assessment. It also suggests that relying only on information collected to assess clinical competence may not be sufficient. Additional criteria, such as structure and style of work-up, should be further explored.

Correlation between clinical syndromes and neuropsychological tasks in unmedicated patients with recent onset schizophrenia.

The aim of this study is to circumscribe the cognitive deficits according to schizophrenic syndromes in a population of sub-acute untreated patients. We have studied the cross-sectional correlation between cognitive deficits and schizophrenic symptoms, in a group of 24 untreated patients (including 17 neuroleptic-naive patients) with recent onset of the disease. A task of alertness, a working memory (WM) test (including two levels of difficulty) and an abbreviated version of the Wisconsin Card Sorting Test (WCST) were selected. WM deficits and poor performance on the WCST were highly correlated with disorganized symptoms, modestly with the positive syndrome and not with the negative syndrome. Thus, disorganized symptoms, more than any other, appear to be related to the impairment of executive function and WM in recent onset unmedicated patients with schizophrenia.