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REDDIT Thread RE: UPenn radiology extender program
Posted by Unknown Member on October 30, 2020 at 2:09 pm[link=https://www.reddit.com/r/Residency/comments/jkzjpf/upenn_doubling_down_on_their_radiology_extender/?utm_source=share&utm_medium=ios_app&utm_name=iossmf]https://www.reddit.com/r/…pp&utm_name=iossmf[/link]
I found this thread on Reddit. Post is official response from UPenn regarding their nonsense PQI project designed to belittle and humiliate the rads residentsI love the Threatening comment in the last line. Meanwhile, they are actually threatening radiologys future
UPenn doubling down on their “radiology extender” nonsense
byu/theroadtodrwaldo inResidencyerasmopa replied 4 years ago 7 Members · 19 Replies -
19 Replies
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Are the residents there to learn or make the attendings day easier?
So their conclusion is their residents are no better than their techs, so not well trained?
Yikes
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Has there been any talk of program management stepping down? This is a scandal and further if true points to the quality of their education. Im very surprised there is not backlash or legal action from the residents against what is very clearly systemic harassment. It betrays just culture, and a culture of safety and publicly publishes resident performance metrics. Highly unethical.
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It’s all about media attention.
No media attention = the backlash is silenced.
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I posted this on the med student discussion and thought Id just post it here as well.
Ok, I read the link to Diagnostic Imaging shared above. There is one word on that link which disgusts me. It is the word outperform in the title. My question is whether that word came from the original Penn article or faculty or whether that word came from Whitney Palmer who wrote the synopsis for DI.
I say that because there is absolutely nothing in the paper that implies the techs outperformed the residents. The article states that the accuracy of interpretations was similar between residents and techs. And that is no insult to the residents. Most chest x rays are either normal or have trivial findings. It would take thousands of complex X-rays with rare findings like unexpected pneumothorax or mediastinal hematoma to prove who is more accurate.
The advantage, according to the authors, is that reading out the reports from the techs was faster for attendings. The explanation for this is obvious and simple. They taught the techs to dictate with standardized templates. OBVIOUSLY if all tech reports are standardized and they are not having read outs and receiving teaching and leaving for noon conference, it is going to be more efficient for attendings to read out reports from techs over non standardized reports from residents. That in no way implies they are better.
So I will concede that if the authors used the term outperform or condoned that term it is inexcusable and they should submit a further explanation.
I just think it is a shame an institution should suffer from a poor decision by one or two individuals.
What nobody has touched on is having techs prelim chest x rays has benefits to the residents and attendings. If a big academic institution has 1,000 chest x rays per day and 3 residents on rotation, asking each resident to prelim 300 x-rays hurts rather than helps their education. Anything that can be done to save residents from being scutted out and to keep attendings from quitting from a miserable work day is understandable in my opinion. As a private practice radiologist who reads 30 chest x rays per day I would never hire a tech to prelim chest x rays as it makes no sense. But the reality is different in an academic thoracic department where there are 1,000 chest x rays per day. I dont think there is any role or need for midlevels to interpret chest x rays in general practice, but it may make sense in an academic setting.
I would be interested to know the perspective of active Penn residents on this research or to hear more from the faculty involved.
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A hospital with 1000 cxr a day isnt having residents look over 100% of that . That simply isnt possible.
And Im having a hard time envisioning somewhere truly doing 1000 cxr in a day. Maybe in a giant system with numerous outpatient facilities where it all dumps into one list ? You would have a slew of attendings crushing that list
I also dont see how mid levels would help at all. The study still has to be dictated , ie a doctor has to look at it
And residents use standardized reports too, its not like you cant show a first yr resident what your standard normal is.
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A hospital with 1000 cxr a day isnt having residents look over 100% of that . That simply isnt possible.
-Duh
And Im having a hard time envisioning somewhere truly doing 1000 cxr in a day. Maybe in a giant system with numerous outpatient facilities where it all dumps into one list ? You would have a slew of attendings crushing that list
-I guess UPENN is a tiny health system…
I also dont see how mid levels would help at all. The study still has to be dictated , ie a doctor has to look at it
-This was the whole point of their study whether you agree with it or not
And residents use standardized reports too, its not like you cant show a first yr resident what your standard normal is.
-the residents might all use standardized reports or not. I dont think the article clarifies that. But logic dictates to me that if attendings are reading reports from 2 midlevels and 20-50 residents they are going to find it faster reviewing the standardized style of 2 midlevels compared to those of 20-50 residents
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When did I say UPenn is tiny ? Are they doing 1000 cxr a day ?
Why would there be 20-50 residents reading chest x rays ? Logic says that theres probably less variance in 2 residents than 20-50 mid levels as well, thats probably more so due to the number of people rather than the resident vs mid level thing.
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[link=https://www.diagnosticimaging.com/view/radiology-extenders-outperform-radiology-residents-with-chest-x-ray-interpretations]https://www.diagnosticima…-x-ray-interpretations[/link]
Honestly, how much is it to ask that you read about the article before you start commenting on it and suggesting the chair step down, etc?
Your comments show you didnt read it.
The study had 2 techs reading cases. It was done over 6 months. The institution has about 50 residents. If you know anything about radiology training it is safe to assume most of them read x rays in that time.
The techs each read 150 chest x rays per day. That implies a huge number of x rays each day in the dept. They dont state the total but they do say the cases come from multiple hospitals and outpatient sites.
Its great to have an opinion, but even better if it is an informed opinion.
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Youre drawing some strange conclusion , 300 vs 1000 is a huge difference.
are you a radiologist ? There arent 50 on the service at one time . You train everyone to dictate with the same template. Obviously someone who only reads 100 foot xrays every day is probably going to be more regimented than 40 people who read foot X-rays for a month a year. This is such an illogical and basic point its sad.
Have a good day, hope UPenn is paying you well.
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Are the cases even equal? Like are they just reading all outpatient pre work screening cxr while the residents are reading icu xrays?
Im pretty sure someone that had to read 150 icu xrays per day would either a) miss a ton of stuff b) gouge their eyeballs out
C) do both -
Omg, you really are not intelligent. The study took place over 6 months. In that time most residents in the program would read at least one x ray, dont you think? Also, if two techs are reading 300 x rays per day between them that implies a much higher total for the chest department as a whole, dont you think? You also have residents reading cases and as you said yourself attendings reading cases independently.
Im not going to respond to you again because your comments are so uninformed.
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Just to try to make peace with you we are making a lot of the same points. My main point in saying they had 2 techs reading cases and a much larger number of residents was to make the point that that alone explains why it was more efficient for the attendings to finalize the tech reports compared to the resident reports.
Of course it is faster to read out reports from two techs whose reports you see over and over and are structured the same way than reports from a much larger number of residents who may structure the reports differently. It certainly doesnt make the tech reports better, just faster to finalize.
I said 1000 x rays because that seemed like a good estimate. Maybe it was 750, maybe it was 1250, we can both agree it was a large number.
With such a large # of x rays of course you cannot have residents read them all and of course it is going to make anybodyresident, tech, attending miserable to read hundreds of these per day. It was this monotony and the crap reimbursement which motivated them to have techs read x rays in the first place.
I personally agree with you that I would rather read the cases myself than have a tech or resident prelim them for me, but the conclusion of the article was that the tech prelims sped up the process.
I honestly could care less if the Penn Chair lost his job over this. I just would prefer to live in a world where people made such statements without anonymity. I think when people are held accountable for their statements they are much more reasonable and the world is a healthier place.
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I don’t think they should lose their job as a radiologist but they could step down from leadership for sure as this is a gross oversight and the response is basically an FU/sweep under the rug kinda deal .
Like you said I think we agree on a lot.
the speed thing also comes from this sentiment I’ve experienced as a resident in multiple specialties as well as a med student where a PA says xyz, the attending will generally agree with it and move on with their life. They almost never will contradict the midlevel unless something blatantly obvious like for instance recommending a non con CT for a GI bleed in someone with a normal creatinine.
If a med student/resident says xyz, the attending is much more likely to disagree, change the plan or pontificate about a point( which may or may not be for the purpose of teaching).
Its just a different dynamic/mindset, even if you’re comparing a midlevel to an upper year resident like PGY3-5. I have seen this in multiple other specialties as well. I really do not understand it. Personally I think I’m gonna trust what the PGY5 says a lot more than your average midlevel. -
I can’t seem to view the article anymore since it has been taken down. But I wonder if the x-rays were matched in terms of their source. Obviously one ICU cxr can be negative and another can be horrible with 10 lines and various devices etc so you can never perfectly control but I could imagine a similar thing to how NPs were saying they can manage diabetes as well as FM docs so they are just as good at everything.
Basically where they’re saying a midlevel can read an outpatient cxr faster than a resident, while the resident is reading the ICU film with 10 lines and etc.
I would also be curious to know if there was a ramp up period to this. It seems very hard for me to imagine a radiology tech reading 150 CXR without any prior training and doing an acceptable job in the short term. Maybe after a month you get used to that, but that is a lot of volume in something they have never done before apparently, which also seems very fishy. Even if they were given lectures or viewbox teaching, it seems hard to believe. 150 cxr would be brutal for 99.9999999% of all radiologists IMO -
Agree with your points above. I cant see the original article either. It says in there somewhere that the techs were trained for 2 months. I dont think 2 months is long enough to make them more accurate than residents, but I do believe that 2 months of attendings saying to them this is exactly how I want your reports structured and this is exactly the terminology I want you to use would result in reports that are read out faster by the attendings compared to resident reports.
Sitting them down for 2 months and training them on how to dictate reports exactly the way you like and then comparing how quickly you sign their reports to reports by residents who did not undergo the same process is a bit like administering a test to a group of people after showing the answer key to two people and not the rest. In other words their findings were predictable.
They did say they found no difference in accuracy and any differences had more to do with differences in the complexity of the films themselves than the group reading them.
That is why I am baffled as to how DI published an article saying the techs outperformed the residents. That statement is both untrue and unfair.
I hope the people involved explain that disconnect.
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