Informatics takes spotlight in radiology teaching tasks

Developments in radiological education involve not only training the new guard in radiology informatics, but revolutionizing the way all radiologists keep up with medical and technological advancements. Papers at the 2004 RSNA meeting outlined a new informatics-specific curriculum and a novel on-the-fly continuing education model.

As informatics technology continues to explode across the radiology landscape, relevant education becomes increasingly important in preparing radiologists for the digital world.

"Informatics is becoming a subspecialty in radiology, and a formal curriculum is required," said Dr. David Weiss, clinical head of imaging informatics at Geisinger Medical Center in Danville, PA.

The radiology residency program at Geisinger includes an informatics curriculum that meets the six general competencies prescribed by the Accreditation Council for Graduate Medical Education: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

Weiss detailed how each part of the informatics curriculum encourages competency across the six ACGME requirements. Each year of the four-year residency program builds upon knowledge obtained in the previous year. As an example, Weiss followed the interpersonal and communication skills competency through the four years of the curriculum.

In the first year, residents touch on computer basics, including e-mail, PowerPoint presentation, and creation of reports. During the second year, they work on improving skills such as reporting and using macros. Residents entering their third year explore more specific topics such as the principles of speech recognition. In the fourth year, their knowledge base is further developed through discussion of topics like multimedia reporting, the future and efficiencies of communication, and integration.

The program is flexible; during the fourth year, residents with an interest in a particular clinical subspecialty or in informatics as a subspecialty are accommodated.

Not only does the program help residents prepare for a career, it has also fostered an increased interest in informatics at the institution, he said.

Residents' educational needs don't stop when they take on the daily routine of being a radiologist. Keeping up with current medical and technological advances would typically require yearly visits to CME meetings and conferences. But now it is possible to turn minutes of downtime during the workday into valuable CME credits. Researchers at the Medical College of Wisconsin have taken advantage of information technology to develop an electronic learning environment that provides radiological education on demand.

"What we wanted to do was deliver educational 'intervention' at the moment it is needed," said lead author Dr. Charles E. Kahn, a professor of radiology and medical informatics at the college.

The system has four main components. The curriculum component allows the learner to define relevant educational materials and monitor educational progress. The presentation component displays learning modules based on the curriculum and clinical context. The assessment component scores the user's responses for self-assessment purposes, and the feedback component allows users to provide evaluations of the quality of educational materials.

To plug into a clinical context, an e-learning system must be integrated with radiology information systems, PACS, and clinical decision support systems, Kahn said. To facilitate this level of integration, the investigators used the clinical context object workgroup (CCOW) standard. The standard is vendor-independent and provides context management for the system.

The ultimate goal of the system is to deliver content in relatively small nuggets. Because of its assessment capability, it not only can deliver self-evaluation for system users but can also measure how the additional education is actually affecting patient outcomes, Kahn said.

An audience member asked how on-demand learning, even if it is only for 10 or 20 minutes, can fit into overworked radiologists' workflows. Kahn responded that radiologists already engage in daily learning when they encounter clinical questions for which they don't have answers-but they call it decision support. This system is simply an extension of that process.

The just-in-time learning model will be more of a complement to traditional CME meetings than a substitute for them, he said. The Medical College of Wisconsin plans to implement its system in a PACS/RIS environment within six to 12 months.