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Competency-Based Training in Diagnostic Radiology – 3 Novel Methodologies

by Anthony Mancuso, MD

This project blends simulation, asynchronous IT learning tools and classroom methodologies to establish a competency-based curriculum and evaluation and Diagnostic Radiology to date mainly in the realm of critical care radiology.

Gainesville, FL Medical Education

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About this project

The problem we solve:
We are replacing insufficient methodology in Diagnostic Radiology education with a system of competency-based training using modern teaching theory and IT tools not previously available and are creating a curriculum that can be delivered anywhere anytime on a tablet.

About our solution:
There are 3 axes to the solution: Simulation (WIDI Sim) – 65 cases including normal and abnormal imaging studies in particular clinical scenarios are delivered in a environment that simulates an 8 hour shift of a radiologist interpreting studies on behalf of emergency room doctors, specialists and others involved in acute care. Backend analytics then identify observational and interpretive errors that need to be remediated. Curriculum delivery (WIDI Learn)-using advanced IT tools we can deliver on a tablet or computer and educational experience that will eliminate potential harm to patients by teaching a discipline for imaging interpretation, requiring judgment about how this fits into the care of the patient as well as the acuity of the situation. Classroom Radtree-- is a computer-based classroom tool that allows in a tree and branch methodology the instructor to present material and evaluate immediate feedback of all trainees in the room so that the learning session can be modulated to assure movement toward competency in the particular problem at hand. This also includes backend analytics about the concepts being taught and the progress of students.
Progress to date: Simulation – we deliver the simulation on our own to 3 residency programs and then partnered with the American College of Radiology to expand the program to now about 30 programs. In that experience we have recently analyzed results of 250 resident encounters and have done analytics that proved this system identifies significant knowledge gaps us all programs that could cause harm to patients in the emergency medical/critical care setting. Curriculum – we have partnered with the Toshiba Corporation and a Canadian web development company called Medversive to produce a novel means of delivery of curriculum targeted to eventually 600 – 800 competencies and critical care radiology that need to be mastered in order to ensure the delivery of optimal patient care in this environment and avoid the obvious knowledge gaps that we discovered. This is currently in a early beta version online at for feedback but the full functional version will be available within 6 – 8 weeks with a target to complete the entire critical care curriculum in 18 – 24 months. Classroom – this tool is virtually fully development and has been deployed in graduate medical education teaching sessions and is being integrated with our other 2 methodologies to create a" round-trip" in competency-based training in the mode of "flipping the classroom" popularized by several groups involved in modernization of education in general

About Our Team

Dr. Anthony Mancuso, MD
Radiology , Practicing Physician
Location: Gainesville, Florida
Medical school: University of Miami
Bio: I have been the Chairman of the Department of Radiology at the University of Florida College of Medicine for 16 years. I've been at the college for 33 years previously as the clinical developer of the MRI program here and then Associate Chairman for Research. I'm also the president of the physician group practice at the UF College of Medicine. I have an almost 40 year distinguished career as a still practicing neuroradiologist and acknowledged international expert in the area of Head and Neck Radiology. In that regard, I have over 180 peer-reviewed published articles and several major textbooks. At this stage in my career I turned my attention to innovative teaching methods in radiology having recognize the shortcomings of how radiology is taught to vote medical students and residents during my entire career. My current focus is the development of systems that assure competency-based training in radiology becomes the norm. In pursuit of this the last 7 – 8 years we have independently developed a methodology in radiology education to deliver a competency evaluation using simulation methodology that is one of the axes of the program being submitted. This is now currently delivered to about 20 radiology programs in the United States and is an acknowledged success in that it has uncovered very significant gaps in the essential knowledge in the domain of critical care radiology. I have personally developed a novel system for curriculum development to remediate these knowledge gaps that is now ready for deployment. As chairman. I have also nurtured the development of in classroom modern teaching tools that engage student rather than teach passively.
Practice: UF Health
Hospital Affiliation: UF Health Shands Hospital
Title: Professor and Chairman- Dept Radiology UF college of Medicine

About Team Members

Linda Lanier
Associate Professor of Radiology, MD
Biography: Dr. Lanier is been in the Department of Radiology at the UF College of Medicine for about 30 years. Dr. Lanier established herself as a leader in novel approaches using then new IT methodology for teaching anatomy and the domain of radiology to medical students. As an outgrowth of that she consulted in the private sector for several years popularizing this then new approach to medical education in the early 1990's. Dr. Lanier is now the primary architect of the simulation testing methodology developed by our department as a joint venture with the American College of Radiology.
Christopher Sistrom
Associate Professor of Radiology, MD Phd
Biography: Dr. Sistrom has received a PhD in Health Services Administration at the University of Florida. He has over 20 years experience in this field. He works as a consultant for CMS in the evaluation of imaging utilization throughout the United States by way of his affiliation with Brandeis University. He divides his time between his duties at UF College of Medicine and Harvard University/MGH where he analyzes methodology used to modulate physician imaging ordering practices. Is the primary architect of the American College of Radiology imaging appropriateness criteria and a primary consultant to ACR Select. His contributions to our methodology in competency-based training have been in the area of identifying specific competencies and developing grading methodology and backend analytics outcomes

About Our Company

Wisdom in Diagnostic Imaging
Location: Gainesville, Florida
Product stage: market
Sales: Less than $250,000
Employees: 3-5

How We Help Patients

We have identified gaps in knowledge in radiology training that have very significant potential to harm patients. This is in the domain of critical care radiology as it supports the care of patients being seen in the emergency room, in a level I Trauma Ctr., in a high-level comprehensive stroke center as well as in a 1000 bed academic health center full range of critically ill patients. Deficiencies exist across virtually all 20 – 30 radiology programs tested. We have identified and validated systematically errors that are in the domain of observational and interpretive as well as false positive interpretations. All of these situations create potential harm for patients if they are not remediated. There is also the potential for economic harm in the generation of false positive imaging interpretations. The implications of curing these problems with regard to benefits for patients should be obvious. Regard to the purpose of this statement physicians who have observed the development of these 3 programs are shocked when they see the gaps in knowledge that exist. To a person they expect a more robust educational system that eliminates such error.

How We Help Education

This idea is specifically targeted to date at the education of residents. The methodology of simulation and curriculum development as well as the classroom tool can be easily adapted to medical student education. Physicians who are ordering imaging studies should be aware of the clinical scenarios and appropriateness of their ordering habits and radiologist who interpret these images must be aware of their impact in the clinical environment and be fully aware of the acuity and the responsibility of any individual clinical scenario where they are engaged to take care of patients. Competency-based training should be the new methodology of medical education. This will hold all physicians responsible to demonstrate actual mastery. This can be accomplished because of the extraordinary IT tools that are available. There is no question that our system of education will look extremely different within the next decade with the elimination of teaching methodologies that are not up to fully establishing competency and substituting those with putting the responsibility for learning predominantly on the student with optimized input by the educator to eliminate knowledge gaps and promote the acquisition of real competency in the chosen area of medical discipline.

How We Help Physicians

Diagnostic radiologists are actively engaged in triage of care in a very large number of clinical scenarios. We estimate that in the entire field of radiology there may be as many as 3000 individual competencies that need to be mastered with regard to particular clinical scenarios that are represented in the ACR appropriateness criteria. Currently, we are focused on those in the critical care domain because this is the area where harm can occur very rapidly and irreversibly. Improvement in this area will greatly improve the ability of our clinical colleagues to make good decisions in a timely manner based on accurate imaging data interpreted correctly and placed correctly in clinical context while avoiding false positive readings.

Challenge Mission

Mission: We will eliminate observational and interpretive errors in the generation of radiology reports and consultations. This will expedite patient care while improving its quality and safety.
Use of funds: The funding will be used to continue the development efforts of the curriculum tool. This requires intense IT software development, which has largely been self funded. We would hope this would be considered seed funding and lead to more interest in supporting what should be the educational system of the future.
Intellectual Property Status: The intellectual property in these projects is essentially under control of the University of Florida. There has also been joint software development with the American College of Radiology.
FDA Status: This requires no FDA approval.
Personal Message: Eliminating medical error is essential for our patients. They expect us to accept the responsibility to be as competent and error-free as possible. It is time that we embark on true competency-based training to assure that we can meet this expectation so far as possible.


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    05/20/2016 Meg Barron - Private

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    05/10/2016 Brenda Fahy - Physician

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    04/29/2016 David Taylor - Healthcare Innovator

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    04/27/2016 Carter Yates - Entrepeneur

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Anthony Mancuso, MD
Professor and Chairman- Dept Radiology UF college of Medicine
University of Miami

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