Purpose
The urgent need to minimize in-person interactions during the ongoing COVID-19 pandemic has limited trainee access to clinical learning opportunities. With ongoing utilization of virtual platforms for resident education, efforts to maximize their value are essential. Herein we describe a resident-led quality improvement initiative to optimise remote contouring and virtual contour review.
Methods
From April to June 2020, radiation oncology residents at our institution were assigned modified duties. We implemented a program to source and assign cases to residents for remote contouring, and to promote and optimize virtual contour review. Senior residents used a mentorship model to match cases with junior residents. Microsoft Teams software was used for virtual review with the supervising radiation oncologist, including direct observation with immediate feedback. Resident-perceived educational value was prospectively collected and analyzed. Case logs completed after contour review integrated our institution's competency-based medical education (CBME) assessment platform.
Results
All 9 radiation oncology residents at our institution (PGY1-5) participated in the program, and 97 cases were contoured during the evaluation period. Introduction of the RECOVR program coincided with a significant increase in mean cases contoured per week, from 5.5 to 17.3 (p=0.015), and an increased proportion of cases receiving virtual review, from 14.8% to 58.6% (p<0.001). Residents agreed that the overall educational value of virtual review was comparable to in-person review (4.4±0.1 vs. 4.5±0.3, p=0.993; mean±standard error; 5-point Likert scale), and significantly better than no review (3.1±0.4, p=0.003). The value of immediate feedback during virtual review was highly rated at 4.6±0.1, similar to that of in-person review (4.5±0.2, p=0.803), and significantly higher than feedback received post hoc (e.g., email, phone; 3.6±0.2, p<0.001).
Discussion
The implementation of a remote process for contour review led to significant increases in contouring and contour review and was rated as highly as in-person interactions. Challenges of program implementation included issues with software deployment requiring technical support. A strength of this program was that this was a trainee-led initiative. However, the workflow was dependent on added responsibilities for senior residents.
Significance
This initiative led to transformational change in the contour review process at our institution even after apprenticeship rotations were reinstated. It provided residents with a novel means of achieving their educational milestones and ultimately attaining the core RO competencies during the pandemic and beyond. Future work on contour assessment and feedback as part of CBME may be helpful.
Keywords
Contouring, virtual medical education, feedback
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