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Efficacy, Education, Administration, Informatics

E2905. Clinical Reasoning in Radiology: A Practical Guide for Day-to-Day Resident Teaching

Lapierre C1,  Damphousse A1,  Prosmanne O1,2,  Labelle M1,2,  Trop I.1,2 1. University of Montreal, Montréal, Canada; 2. CHUM, Montréal, Canada

Address correspondence to I. Trop (itrop@yahoo.com)

Background Information: Radiologists involved in resident formation are familiar with evaluation processes that focus on residents’ knowledge base and expertise. When dealing with a resident with difficulties, many teachers find it difficult to precisely identify the reason for the difficulties observed, beyond a lack of knowledge. Many radiologists feel uneasy and poorly equipped to evaluate residents’ professional skills as consultants, health advocates, and communicators—essential tools of our profession. Inspired by a clinical reasoning guide developed at our institution, five radiologists with 5–25 years of teaching experience met to dissect the radiologic reasoning process in distinct steps that will allow better assessment of resident difficulties and suggestions for improvement strategies.

Educational Goals/Teaching Points: Radiologists involved in resident teaching often feel poorly equipped to evaluate residents’ difficulties and propose solutions for improvement. The radiology reasoning process can be dissected, from reception of an imaging request and determining its appropriateness until finalization of the interpretation report and communication with the treating physician. Clearly separating steps that comprise the radiology reasoning process allows for the teacher to better help the resident with difficulties, by pinpointing the difficulties more precisely. An accurate evaluation of resident difficulties helps the educator tailor teachings and propose individualized solutions for improvement.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: A guide detailing the radiology reasoning process was developed The radiology reasoning process was conceptualized into the following four categories: Before the examination: This includes the ability to plan, triage, and confirm examination appropriateness. Image analysis: This includes the ability to detect, collect relevant imaging findings, use correct radiologic vocabulary, and summarize collected information. Data synthesis: This includes the ability to synthesize collected information to propose a most likely diagnosis and appropriate alternative options. Communicating results: This includes the ability to communicate results in a clear and efficient manner, including recommendations for further investigations and follow-up. For each of the four categories, the practical guide proposes observable signs that may suggest resident deficiencies, questions to ask to challenge the resident and stimulate self-reflection, and steps that can help the resident progress and surmount a particular difficulty.

Conclusion: An easy-to-use guide of radiology reasoning was developed, presented to experts in medical teaching and radiology residents for feedback, and its content validated and improved based on comments received. The information is now available in an easy-to-consult and visually appealing practical guide that can be used daily in teaching situations to help both teacher and student identify difficulties and find solutions for improvement.