Evaluation of an audit with feedback continuing medical education program for radiation oncologists.
ABSTRACT Meta-analyses demonstrate audit with feedback (AWF) is effective continuing medical education (CME). However, efficacy varies between specialties, with little published radiation oncologist (RO)-specific evidence. We evaluated an AWF CME intervention for ROs determining efficacy, cost-effectiveness, and participant satisfaction.
CME program: The CME incorporated fortnightly random patient chart audit, scoring management adequacy via a checklist. Scores were presented at a same-day institutional meeting, and case management discussed. Senior peers provided individualized, educational feedback.
Changes in behavior and performance were evaluated by chart review of new patients seen by ROs in the 2 months before commencement of AWF (T0), and at months 13-14 of the program (T1). Behavior and performance were evaluated with a validated, reproducible, 19-item instrument. Criteria for each case audited included 10 targeted and 3 nontargeted behavior items and 6 performance items; each scored 1 point if deemed adequate (maximum score 19). Cost-effectiveness was reported as cost to the institution per item point gained. The mean score (out of 5) of a 14-item questionnaire evaluated program perception.
A total of 113 and 118 charts were evaluated at T0 and T1, respectively. Mean score of targeted behavior improved between T0 and T1 (from 8.7 to 9.2 out of 10, P = .0001), with no significant improvement of nontargeted behavior/performance items. Annual costs and cost-per-point gained were US 7,897 dollars and 15 dollars. Participant satisfaction was positive, increasing after efficacy result distribution (P = .0001).
Audit with comparative, individualized, educational feedback is cost-effective and positively perceived CME, significantly improving targeted RO behavior. Oncologists' CME design and evaluation require further research.
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ABSTRACT: This report is part of a series of white papers commissioned for the American Society for Radiation Oncology (ASTRO) Board of Directors as part of ASTRO's Target Safely Campaign, focusing on the role of peer review as an important component of a broad safety/quality assurance (QA) program. Peer review is one of the most effective means for assuring the quality of qualitative, and potentially controversial, patient-specific decisions in radiation oncology. This report summarizes many of the areas throughout radiation therapy that may benefit from the application of peer review. Each radiation oncology facility should evaluate the issues raised and develop improved ways to apply the concept of peer review to its individual process and workflow. This might consist of a daily multidisciplinary (eg, physicians, dosimetrists, physicists, therapists) meeting to review patients being considered for, or undergoing planning for, radiation therapy (eg, intention to treat and target delineation), as well as meetings to review patients already under treatment (eg, adequacy of image guidance). This report is intended to clarify and broaden the understanding of radiation oncology professionals regarding the meaning, roles, benefits, and targets for peer review as a routine quality assurance tool. It is hoped that this work will be a catalyst for further investigation, development, and study of the efficacy of peer review techniques and how these efforts can help improve the safety and quality of our treatments.Practical radiation oncology. 07/2013; 3(3):149-156.
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ABSTRACT: To describe current patterns of practice of radiation oncology peer review within a provincial cancer system, identifying barriers and facilitators to its use with the ultimate aim of process improvement. A survey of radiation oncology programmes at provincial cancer centres. All cancer centres within the province of Ontario, Canada (n=14). These are community-based outpatient facilities overseen by Cancer Care Ontario, the provincial cancer agency. A delegate from each radiation oncology programme filled out a single survey based on input from their multidisciplinary team. Rated importance of peer review; current utilisation; format of the peer-review process; organisation and timing; case attributes; outcomes of the peer-review process and perceived barriers and facilitators to expanding peer-review processes. 14 (100%) centres responded. All rated the importance of peer review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest rated perceived benefits of peer review (each median 9/10). Six centres (43%) reviewed at least 50% of curative cases; four of these centres (29%) conducted peer review in more than 80% of cases treated with curative intent. Fewer than 20% of cases treated with palliative intent were reviewed in most centres. Five centres (36%) reported usually conducting peer review prior to the initiation of treatment. Five centres (36%) recorded the outcomes of peer review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; a critical mass of radiation oncologists was the most important limiting factor (median 6/10). Radiation oncology peer-review practices can vary even within a cancer system with provincial oversight. The application of guidelines and standards for peer-review processes, and monitoring of implementation and outcomes, will require effective knowledge translation activities.BMJ Open 01/2013; 3(7). · 2.06 Impact Factor
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ABSTRACT: Although the value of peer review is increasingly recognized, there is little research documenting its impact in the setting of stereotactic body radiation therapy (SBRT) for lung cancer. This study determines the dosimetric effect of peer review of tumor and normal tissue contouring in lung SBRT planning. Forty anonymized lung SBRT plans were retrospectively evaluated post treatment. Each plan was independently reviewed by two to three radiation oncologists using established institutional guidelines. For each structure, reviewers recorded recommendations for "no change," "minor change," "major change," or "missing contour" and provided a modified or new contour as needed. Dose-volume histograms were analyzed for dosimetric violations. Among 472 contoured structures evaluated, recommendations from peer review were 107 major change (23%), 176 minor change (37%), 157 no change (33%), and 32 missing (7%). Common major changes involved the skin (n = 20), heart (n = 18), and proximal bronchial tree (n = 15). Dose constraints were not achieved for 25 new or recontoured structures (5%), of which 17 involved the planning target volume (PTV). Among cases with PTV violations, the mean prescription dose coverage to the modified PTVs was 90%, compared with the protocol standard of greater than or equal to 95% coverage. The remaining violations involved the ribs (n = 5), spinal canal (n = 2), and heart (n = 1). Peer review of structure contouring resulted in significant changes in lung SBRT plans. Recontouring of several plans revealed violations of dose limits, most often involving inadequate PTV coverage. Peer review, especially of target volume delineation, is warranted to improve consistency and quality in lung SBRT planning.Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 04/2014; 9(4):527-33. · 4.55 Impact Factor