Initial results of the Practice Accreditation Resident Reviewer Program (PARRP): a pilot study to educate residents about radiation oncology practice accreditation through mentored chart review

Summary: While instruction in patient safety and quality improvement is a core requirement for radiation oncology graduate medical education, many residents feel their training in this domain is inadequate. To address this discrepancy, we developed a mentorship program that allows residents to serve as junior reviewers within the American College of Radiation Oncology (ACRO) practice accreditation program. Herein, we present the initial results of this program. In this pilot study, participating residents served as junior reviewers with the ACRO accreditation program and completed 4 cycles of chart review assessing quality of treatment and documentation. Each chart review cycle focused on a different disease site (thoracic, genitourinary, breast, or gastrointestinal). During each cycle, residents were paired 1:1 with an experienced accreditation faculty member. Both resident and faculty independently reviewed the same set of charts and scored documentation quality using a pre-specified rubric. After chart evaluation, the faculty met with residents in-person or via videoconference to discuss scoring and provide feedback. At the beginning and end of each chart review cycle, residents were surveyed on their attitudes and confidence in chart review. Responses were scored using a modified Likert scale ranging from 1 (not at all confident/useful) to 7 (very confident/useful). A total of 3 residents and 4 faculty mentors participated in this pilot study. Participating residents were PGY-4s at time of study initiation and PGY-5s at time of study completion. Faculty mentors were disease site experts who had >11 years of experience as an attending radiation oncologist and >2 years of experience of practice accreditation experience. Across the 4 cycles of chart review, residents reviewed a total of 15-16 charts (3-4 charts per cycle) and spent a median of 40 min (range 20-50 min) evaluating individual charts per cycle. The median length of resident-mentor feedback meetings was 31-60 minutes (range 10-60+ minutes). Residents’ confidence in their chart review abilities increased with each cycle of chart review: pre-cycle confidence increased from a median of 3 (range 2-4) in cycle 1 to a median of 5 (range 5-7) in cycle 4; while post-cycle confidence increased from a median of 4 (range 4-5) in cycle 1 to a score of 6 for all participants in cycle 4. Residents’ perceptions on the need for additional cycles of chart review decreased over time: after cycles 1 and 2, 100% of residents felt additional cycles were needed to improve their confidence in chart review. By cycles 3 and 4, this decreased to 66% and 0% of residents, respectively. In this pilot study, we demonstrated that mentored chart review improved resident confidence in practice accreditation. Resident confidence appeared to peak after 4 cycles of chart review. We plan to expand this program to include more residents and faculty mentors. Niema B. Razavian (he/him/his), MD (Presenting Author) - Department of Radiation Oncology, Moffitt Cancer Center; Alexis Schutz, MD (Co-Author) - Advent Health; Leslie Chang, MD (Co-Author) - University of Minnesota; Srinath Sundararaman, MD (Co-Author) - MEMORIAL REGIONAL HOSPITAL SOUTH; Rojymon Jacob, MD (Co-Author) - University of Mississippi Medical Center; Kathryn Huber, MD, PhD (Co-Author) - Beth Israel Deaconess Medical Center; Steven J. Feigenberg, MD (Co-Author) - University of Pennsylvania; Jaroslaw Hepel, MD (Co-Author) - Brown Health