FeatureThe voice of experienceThe Challenging Case Conference: Initial Observations and Feedback
Introduction
Medical errors provide crucial learning opportunities for all physicians [1]. Unfortunately, the analysis of errors is an underemphasized practice during radiology residency training. As a step toward addressing this issue, in the fall of 2009, our department's residency education committee implemented a monthly resident-run conference, the “challenging case conference,” in which residents discussed their own errors among peers in a confidential setting. This conference's structure differs from standard error conferences at which each case is anonymously presented by someone without clinical involvement in the case [2, 3]. In challenging case conferences, residents volunteer to present cases they have read. Moreover, residents may present any difficult or interesting case, whether or not they initially misinterpreted the case.
In this report, we first outline the structure of the challenging case conference, then analyze our initial experience with the conference to evaluate its feasibility as an educational tool for radiology residents. To this end, we assess the diversity of the case the material presented (by organ system, imaging modality, and patient age), the number of errors presented, error types presented, resident participation levels, and resident feedback.
Section snippets
Structure of the Challenging Case Conference
The challenging case conference is a monthly, 45-minute, resident-run conference in which residents volunteer to present interesting, difficult, or missed cases. Presentation content is left to the presenter's discretion but generally involves discussing the pertinent imaging findings, differential diagnosis, final diagnosis, and any interpretive difficulties. A group discussion of the case follows. Typically, 3 to 5 residents present a total of 10 to 12 cases per conference.
Presenting at
Initial Experience and Feedback
To assess our experience with the challenging case conference, we retrospectively reviewed conference summaries and resident participation data for each of the 13 conferences held from January 2010 through August 2011. During this period, a total of 137 cases were presented. Seventy percent of the residents in attendance presented cases.
Each presented case was categorized by imaging modality and organ system (Figure 1). Each case may have involved more than one imaging modality or organ system.
Discussion
The challenging case conference is structured to balance several goals. These include sharing a diversity of instructive case material, encouraging wide participation, and minimizing resident embarrassment. Our initial experience reveals interesting areas of success as well as areas in need of improvement.
To minimize resident embarrassment, the conference is structured so that presenting cases is entirely voluntary, attending physicians do not attend the conference, and conference summaries
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Cited by (3)
Random Versus Nonrandom Peer Review: A Case for More Meaningful Peer Review
2018, Journal of the American College of RadiologyCitation Excerpt :By removing several of the major barriers to reporting cases with diagnostic error using the random approach and developing a process whereby everyone can learn from each other’s mistakes, we believe we were able to achieve the stated goal of peer review: performance improvement through education and systematic interventions. This was accomplished by adhering to best practices in collecting and reviewing cases, which included anonymization, strategies to reduce or eliminate various types of biases, and open discussion of cases with a focus on education and performance improvement in a nonpunitive environment [10,17,18]. Several recent articles have proposed strategies to make RADPEER more meaningful [9,19].
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