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Exploring the Merits of a Teleradiology Fellowship, Part 2


A teleradiology fellowship that offers an information technology (IT) component and dedicated time with teleradiology attendings to learn tricks of the trade with workstation navigation could go a long way toward reducing downtime and maximizing efficiency.

Last week, after poking a bit of fun at the idea, I started to share my vision of what a teleradiology fellowship might look like. It included didactic sessions regarding the administrative and logistical stuff that underpins any viable telerad practice. However, I didn’t get into what the fellows would actually be doing with most of their time.

The first type of rotation, as I mentioned last week, would cover new material that most radiology residencies completely ignore. This would include the IT infrastructure that makes teleradiology possible. This knowledge is also vital to modern onsite radwork unless you happen to still be using films … but there is a key difference.

Suppose you’re working in your hospital or imaging center, and suddenly your workstation isn’t doing what you need it to do. Perhaps the software is crashing, your connection to the network is lost, clicking the mouse doesn’t do anything, etc. Maybe you’ve got enough savvy to try this or that, and sometimes your flailing might even work.

However, unless you have been extremely lucky in this field, that is far from the norm. Usually, you wind up limping along at half-speed if you’re not completely dead in the water. There is not much to do but shrug and take a break until tech support gets around to your rescue. Could that be awhile? Sure, but you can’t do much else. Besides, you’re salaried.

Unfortunately, this is not the case in many walks of telerad life. Even if your compensation is not entirely pay-per-click, chances are productivity is still a big piece of your action. Every moment taken away from your ability to read cases is a swipe at your bottom line. You are also working remotely, and IT can’t just stroll down a hallway for a visit. All of the help you’re going to get is via phone (or instant message if that is still working).

That also assumes your tech support is going to be a help. Maybe that won’t be the case. Who knows what bargain-basement service your telerad employer is using in the name of saving a few bucks? Even if the tech support is halfway decent, the first thing they’re going to do with you is go through a tedious series of troubleshooting steps you have heard way too many times before. Is everything plugged in? Turn everything off and on again, etc.

Wouldn’t it be nice if you, as the rad so heavily dependent on your workstation rig, had a decent chunk of the tech support person’s know-how? Maybe you could do your own troubleshooting, and only have to call for help 50 percent, even 25 percent as frequently. When you did wind up talking to tech support, you could begin by telling them everything you already did so they could cross that much off their checklist and skip ahead to whatever you hadn’t already investigated.

On top of that, perhaps you could tell him or her that your fellowship had you spend three-plus months in IT training on all of the stuff relevant to working in telerad. They wouldn’t have to take your word for it that you already confirmed that items A through M aren’t your issue, and to start with N. You would have a fellowship diploma to prove it! This may also be of interest to any prospective employers who might like to have your value-added skills in their workforce.

Fellows would, indeed, spend rotations of their fellowship hanging out with the IT people employed by (or contracted with) the telerad group. It would be part of IT’s job: Have the fellows shadow them, watching and learning whatever tech support was up to or routine maintenance stuff if things were running smoothly.

When there was nothing at all to be done, the IT folks could just sit with the fellows and give them a “what you need to know” practical education. It would be in the techies’ interest after all. A well-versed fellow could help them on the job and might one day be a more self-sufficient customer.

The other major type of rotation would, in fact, be practicing radiology. After all, it wouldn’t be all that helpful for a rad to graduate residency and then spend a year letting his interpretive skills get rusty.

This wouldn’t just be more of the same-old, same-old reading room routine. As I noted before, the fellowship should be in an actual teleradiology group. Well, seasoned telerads would be precisely who the fellows sit with, and the focus would be on seeing and assimilating the habits and skills that made those attendings successful telerads. The fellows would learn how to gain speed and efficiency without sacrificing accuracy.

In residency, speed is far from the goal. One is supposed to be learning the fundamentals of diagnostic radiology. One doesn’t rush things along while a resident is trying to grasp the basics or hurry on to the next case when there are still valuable teaching points on the last one.

A fellow planning on doing telerad needs to get his or her numbers up, and that’s not just about reading a lot of cases to gain experience and confidence (although that will happen in the process). Rather, the telerad attendings will show their fellows “how I do it.” That includes all of the tricks they have learned. This includes using keyboard shortcuts and voice commands, programming mouse buttons, arranging PACS toolbars, setting preferences, etc. Of course, this training would also include making the best use of all the tools offered by voice recognition software: macros within macros, templates, autocorrect features, etc.

Left to their own devices, new graduates going into telerad might take years to figure out all of this on their own. Even then, there might be tricks they have never encountered. A couple of decades in, they might feel too set in their ways to take on new habits. However, if you showcase all of this information while they’re still at the beginning of their careers, especially during rotations with a dozen different attendings who each have their own proven methods (and anecdotes to share from their previous telerad gigs complete with cautionary tales), you are giving the fellows access to a complete arsenal of “best practices.”

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Nina Kottler, MD, MS
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