RSNA 2017: The advantages of using peer learning vs peer review

The peer review model traditionally found in radiology is slowly losing ground as many it not ideal for examining mistakes. At RSNA 2017 in Chicago, David Larson, MD, MBA, vice chair of education and clinical operations in the department of radiology at Stanford University School of Medicine, explained why peer learning is a better option for organizations and practices to use when analyzing interpretation errors.

“The major problem with peer review is that it kicks people when they are down and turns guilt into shame,” Larson said. “Guilt tends to be temporary, and shame is all encompassing and debilitating. We feel abandoned by our colleagues when we really feel like we should be supported.”

There are two victims when there is an error in interpretation. The first is the patient, but there is a second victim—the interpreter, who feels terrible because of the mistake.

“Peer learning is really a different paradigm than peer review,” Larson said. “Peer review is based on measuring how often radiologists are reading errors. Peer learning is sacrificing the understanding of how often the errors occur and really learning from the errors of one another.”

The 3 fundamentals of peer learning

Peer learning, Larson said, is based on three pillars: feedback, learning and improvement. Feedback should be provided in a constructive manner and in turn should be received with graciousness and humility. Acceptance, even if there is disagreement regarding feedback provided, is critical.

Learning is more of a conversation rather than counting past mistakes. In most cases, a moderator generally reviews cases with errors, and then there is preparation for a “learning conference.” The cases are identified, presented and discussed.

“If I make an error there is a chance that others in the organization or practice may also make that same error or vice versa,” Larson said. “If others make an error, there is a good chance I might make the same error.”

For the conference to be successful, a constructive tone must be maintained and preserved. Larson noted comments may be interjected during the conference that could take the conversation off tone, but the moderator must remain firm.

The conference is meant to emphasize learning points, including potential pitfalls and strategies for preventing error. Larson added the conference should also look at the positive cases or “great calls.”

“A ‘great call’ is defined as a difficult case where someone could potentially misinterpret a finding, but they actually made the correct finding,” he said. “This is a great opportunity to use the same case material in a more constructive manner because the group can celebrate the fact that someone made the right call, which can be uplifting and can promote a positive culture.”

Improvement is the primary purpose of the peer learning program. Individuals may need to improve their interpreting skills. Larson explained that a peer learning model takes the assumption that all radiologists have opportunities where they can improve. If there’s a space where colleagues need to focus, they should make themselves available to coach. And peer learning should really be viewed as a way to rally behind colleagues.

“At some point, we are going to be that colleague and we really should support each other to help improve our weaknesses and build upon and utilize our strengths for our practices and organizations,” Larson said.