Quality and Safety Officer, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2022 Oct;19(10):1138-1150. doi: 10.1016/j.jacr.2022.04.012. Epub 2022 Jul 6.
Prior studies used submission numbers or report addendum rates to measure peer learning programs' (PLP) impact. We assessed the educational value of a PLP by manually reviewing cases submitted to identify factors correlating with meaningful learning opportunities (MLOs).
This institutional review board-exempted, retrospective study was performed in a large academic radiology department generating >800,000 reports annually. A PLP facilitating radiologist-to-radiologist feedback was implemented May 1, 2017, with subsequent pay-for-performance initiatives encouraging increasing submissions, >18,000 by 2019. Two radiologists blinded to submitter and receiver identity categorized 336 randomly selected submissions as a MLO, not meaningful, or equivocal, resolving disagreements in consensus review. Primary outcome was proportion of MLOs. Secondary outcomes included percent engagement by subspecialty clinical division and comparing MLO and report addendum rates via Fisher's exact tests. We assessed association between peer learning category, pay-for-performance interventions, and subspecialty division with MLOs using logistic regression.
Of 336 PLP submissions, 65.2% (219 of 336) were categorized as meaningful, 27.4% (92 of 336) not meaningful, and 7.4% (25 of 336) equivocal, with substantial reviewer agreement (86.0% [289 of 336], κ = 0.71, 95% confidence interval 0.64-0.78). MLO rate (65.2% [219 of 336]) was five times higher than addendum rate (12.9% [43 of 333]) for the cohort. MLO proportion (adjusted odds ratios 0.05-1.09) and percent engagement (0.5%-3.6%) varied between subspecialty divisions, some submitting significantly fewer MLOs (P < .01). MLO proportion did not vary between peer learning categories.
Educational value of a large-scale PLP, estimated through manual review of case submissions, is likely a more accurate measure of program impact. Incentives to enhance PLP use did not diminish the program's educational value.
先前的研究使用提交数量或报告附录率来衡量同行学习计划（PLP）的影响。我们通过手动审查提交的病例来评估 PLP 的教育价值，以确定与有意义的学习机会（MLO）相关的因素。
这项机构审查委员会豁免的回顾性研究是在一个每年生成超过 800,000 份报告的大型学术放射科进行的。2017 年 5 月 1 日实施了促进放射科医生之间反馈的 PLP，并随后实施了按绩效付费的举措，鼓励提交量增加，到 2019 年超过 18,000 份。两名对提交者和接收者身份均不知情的放射科医生将 336 份随机选择的提交分为有意义、无意义或模棱两可的 MLO，在共识审查中解决分歧。主要结果是 MLO 的比例。次要结果包括按专业临床科室划分的参与率，并通过 Fisher 精确检验比较 MLO 和报告附录率。我们使用逻辑回归评估同行学习类别、按绩效付费干预措施以及专业科室与 MLO 之间的关系。
在 336 份 PLP 提交中，65.2%（219/336）被归类为有意义，27.4%（92/336）为无意义，7.4%（25/336）为模棱两可，具有较高的审查者一致性（86.0%[289/336]，κ=0.71，95%置信区间 0.64-0.78）。该队列的 MLO 率（65.2%[219/336]）是附录率（12.9%[43/333]）的五倍。MLO 比例（调整后的优势比 0.05-1.09）和参与率（0.5%-3.6%）在专业科室之间有所不同，一些科室提交的 MLO 明显较少（P<.01）。MLO 比例在同行学习类别之间没有差异。
通过手动审查病例提交来估计大型 PLP 的教育价值，可能是衡量计划影响的更准确方法。增强 PLP 使用的激励措施并没有降低该计划的教育价值。
