0:01

So I mentioned look at the prior reports

0:04

because you should trust your colleagues,

0:06

but not completely.

0:08

And I gave you that example of the patient who had

0:12

periaqueductal high signal intensity that was ascribed

0:15

to multiple sclerosis,

0:16

but ended up being in impatient who had thiamine deficiency.

0:20

So review the cases as if you are reading it yourself

0:23

for things like peer review

0:26

and also review the cases without copy

0:30

and pasting your colleagues' previous

0:34

report into your report.

0:35

Look at it afresh.

0:39

I have found personally that when I do, um,

0:44

and get the peer review from my colleagues,

0:47

the vast majority of cases

0:49

that I make an error on are ones in which a trainee has done

0:54

the preliminary report and in particular the fellows.

0:58

Uh, I think this is centered in the fact

1:01

that I trust the fellows.

1:02

They're all brilliant individuals.

1:04

They've gone through excellent residencies.

1:06

They've come to do their neuroradiology fellowship at Johns

1:09

Hopkins, so they're high quality individuals

1:11

and I think I slack off, I'm a little bit more lackadaisical

1:16

when a fellow has read a prior report

1:20

and I'm signing off on it.

1:23

Um, so my error rate when it's me alone reading the case

1:27

is much lower, 10 times lower

1:30

than my error rate when I'm signing a resident or,

1:33

or fellow, uh, error, uh, report.

1:37

So, um, beware of that complacency

1:42

that you trust your trainee

1:45

or the person you're reading the case with.

1:47

So long reports, you know, I sometimes

1:51

get lost in the gibberish of the long report of the,

1:55

of the trainee that they might, you know,

1:58

be talking about the quality

1:59

of the lens implants in patients

2:01

who have cataracts, for example.

2:03

So that tends to me, I get sort of dismissive

2:08

and a little bit, um, bored.

2:11

So gotta be careful about that.

2:13

So look at the case on your own before you're signing off.

2:15

So look at the case.

2:17

Do not look at the report before you look at the case.

2:21

Make your judgment, then look at the report of the trainee

2:24

or the individual who you're reading the case with.

2:28

So we've looked at, um, neuroradiology findings, missed

2:31

and misinterpreted by residents and fellows

2:34

and, um, you know, it, it is a fact that, um,

2:39

that attendings make errors in and of themselves,

2:42

but the rate of errors

2:44

of finalized reports on resident reports

2:46

and fellows reports is higher nonetheless.

2:50

So change the practice. All.

2:52

A lot of my non my missed cases were detection misses on

2:55

cases I've read with a trainee.

2:57

The other thing is that I don't use templates.

2:59

My trainees almost all use templates.

3:02

To me, it's harder to read the templated report than to skim

3:06

through the a non templated report.