Radiology resident education

Interpersonal and Communication Skills Training for Radiology Trainees Using a Rotating Peer Supervision Model (Microteaching)¹

Examine the cost of MRI operations before and after implementation of interpersonal skills training to reduce unanticipated patient-related events in an academic medical center.

Teams at four MRI sites (two hospital-based, two freestanding) were trained in evidence-based communication skills in February to April 2015. Training was designed to enable staff members to help patients mobilize their innate coping skills in response to any distress they experienced during their MRI visit. Data were collected before training and afterward from January to June 2016. Staff reported the incidence of disruptive motion, sedation use, MRI delays, incomplete examinations, and no-shows. Cost and revenue associated with MRI operations and staff and physician costs were estimated using Medicare and private insurance rates and data from the US Bureau of Labor Statistics.

The study included 12,930 outpatient MRI visits. From baseline to follow-up, average monthly patient volume increased from 1,105 to 1,463 at hospital MRI sites and from 245 to 313 at freestanding MRI sites. Patient factors necessitating sedation or interfering with image progression or quality decreased from 9.0% to 5.5% at hospital sites and from 3.1% to 1.2% at freestanding sites. These changes translated into a reduction in operational costs of $4,600 per 1,000 scheduled patients and an increase in profit of $8,370 per 1,000 scheduled patients in hospital MRI sites, and a corresponding increase in operational costs of $1,570 per 1,000 scheduled-patients and an increase in profit of $12,800 per 1,000 scheduled patients in freestanding MRI sites.

We found significant improvements in MRI operational efficiency after interpersonal skills team training, which were associated with reductions in costs and growth in revenue.

ACGME expectations for radiology trainees' proficiencies in communication skills pose a challenge to program directors who wish to develop curricula addressing these competencies. Numerous educational resources and pedagogical approaches have emerged to address such competencies specifically for radiology, but have yet to be systematically catalogued. In this paper, we review and compile these resources into a toolkit that will help residencies develop curricula around patient-centered communication. We describe numerous web-based resources and published models that have incorporated innovative, contemporary pedagogical techniques. In undertaking this compilation, our hope is to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.

The transformation of health care from a seller's market to a consumer's market has pushed the element of patient satisfaction into the forefront of various tools that evaluate medical facilities, including those used by Medicare when weighing reimbursement to hospitals for patient care. Research has identified good communication skills to be a key factor in ensuring better patient outcomes and nurturing patient satisfaction. Because of the growing amount of money at stake for patients' satisfaction with a facility, the communication skills of individual health-care providers are bound to impact their employees' reimbursement, bonuses, and promotion options. Although the dangers of “poor communication” are evident, “poor communication” is a primary reason for filing a law suit in >80% of cases. Identifying the characteristics of “good communication” has been difficult. One factor that adds to the confusion is that research has found some long accepted codes of professional communication protocol to actually be counterproductive. Another factor that adds to the uncertainty is that accurate interpretations of some communication events are counterintuitive. Fortunately, it has been possible to extract observable, proven, and teachable “good communication” behaviors from large-scale trials in the radiology department. The resultant Comfort Talk™ approach to communication includes rapid rapport techniques, patient-centered talking styles, and the use of hypnotic language. This article overviews some of the Comfort Talk™ approaches to patients interaction and provides operational summaries of a sampling of specific Comfort Talk™ communication techniques, which nurses, technologists, and other health-care workers can implement in their own practices.

Assess whether staff training in advanced rapport skills and self-hypnotic relaxation techniques reduces noncompletion rates during magnetic resonance imaging (MRI).

All staff of a free-standing MRI facility was invited to 3 hours of preparatory communication lectures. Half of the practice was then engaged in intensive training. Clerical personnel and nonlicensed health care professionals received training in advanced rapport skills only (8 hours); licensed health care professionals were trained in advanced rapport skills plus rapid hypnotic techniques (17 hours). Content was adapted so that no interruptions of workflow would become necessary. The format included lectures, large group discussions, small group practice, and a microteaching exercise.

During the quarter of operation before the training 1.2% (80 of 6,654) of patients could not complete their studies. After training, 0.74% (52 of 7,008) patients did not complete their scans (P < .01). Noncompletion rates of scans on the open magnet, on which the most anxious patients were scheduled, decreased from 3.43% (37 of 1,078 patients per quarter) to 1.45% (19 of 1,098). After staff was informed that the MRI partnership would be dissolved and personnel might be transferred or laid off, the noncompletion rate increased again, although not to the original levels; then, after partial dismantling of the facility, leveled off to 0.92% overall and 1.84% on the open magnet. Success was maintained at 1-year follow-up.

Team training in advanced rapport skills and self-hypnotic relaxation techniques significantly reduces MRI noncompletion rates. Personnel distress can adversely affect the patient experience.