More productive academic radiologists make better teachers

Radiologists with high rates of clinical productivity are likely also better teachers for residents, according to data published this month in the Journal of the American College of Radiology.

Physicians working in academic radiology departments often face challenges their counterparts in non-teaching hospitals don’t, first author Cynthia B. Walsh, MD, of the department of radiology at the University of Ottawa in Canada, and colleagues wrote in JACR. Unlike the standard radiologist, those working in academic environments have to achieve a balance between their own clinical output and providing a quality education for residents—and that goal is becoming increasingly daunting.

“The challenges of balancing clinical productivity and resident teaching in radiology may increase as we experience changes within our medical system,” Walsh et al. wrote. “Recent stressors such as fee cuts, increased productivity requirements, patient-centered care initiatives and frequent multidisciplinary rounds have increased demand on radiologists and raised concern regarding the ability to maintain high-quality resident teaching.”

Not only are hospitals faced with those obstacles, the authors said, but they have poor methods for measuring radiologists’ success. Most practices’ tried-and-true methods for gauging productivity involve relative value unit measurements, which fail to capture quality.

In a retrospective study at the researchers’ Canadian institution, Walsh and her team studied the correlation between productivity, as measured by the RADAR metric, and teaching quality, as measured by residents themselves. The research spanned three years, during which 63 radiologists took part in the study.

The authors said their practice had been using RADAR—or the RADiologist Activity Reporting Productivity Metric—prior to the study, and that the flexibility of the tool allows for individual staffs to assign points for certain clinical or academic tasks based on their own unique work environment. Radiologists received an individual RADAR report weekly, and teaching evaluations for radiologists were submitted by residents annually. Physicians were graded on informal and formal teaching, lectures and rounds.

Comparing the two metrics, Walsh and co-authors found 68 percent of radiologists had a positive association between productivity and teaching quality—meaning that as their productivity increased, so did their teaching scores. But, the authors said, the link was relatively weak.

“This retrospective evaluation of radiologist teaching evaluated by residents identified a weak positive association between radiologist productivity and quality of resident teaching,” they wrote. “This finding may be considered surprising by some, because resident teaching is typically seen as a hindrance to clinical productivity. However, this conception may be based on a single study that consisted of a discrete assessment of radiologists working with and without a first-year resident.”

Walsh and colleagues said that because their results were so geared toward their institution’s characteristics, it might be hard to generalize the findings. They suggested future research might try to establish links between clinical productivity and other metrics, like quality of reporting.

“Clinical productivity need not necessarily negatively affect teaching, but to accomplish this, a physician needs credit for time spent teaching,” the authors wrote. “Resident productivity should contribute to total staff productivity. Finally, it is useful for productivity reports to incorporate credit for nonclinical activity.”