Integration of Plan Review into Resident Clinical Didactics

Abstract

<h3>Background</h3> While treatment planning complexity has increased significantly, residents report insufficient exposure to treatment planning. Review of treatment plans with an attending is highly variable, with 71% of residents reviewing ≤50% of plans with an attending (Wu et al, 2020). We sought to integrate treatment planning and plan review longitudinally into our clinical didactics. <h3>Methods</h3> Thirteen clinical attendings were invited to lead weekly plan review sessions (PRS) which were scheduled in one-hour slots following chart rounds. Attendings chose which case(s) they wished to review. Surveys with a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) were administered to attendings and residents after 21 sessions to gather feedback on the program, with results reported as median score [interquartile range]. <h3>Results</h3> Twelve attendings led a total of 21 sessions over 35 weeks from July 1, 2021 through March 3, 2022. Five sessions were canceled due to unplanned attending conflicts and were replaced with ASTRO-ARRO "Meet Me in Treatment Planning" webinars. The remaining nine weeks were not scheduled due to Mortality, Morbidity and Improvement conferences, holidays, or outside lecturers. Ten attendings and ten residents participated in the surveys. Both attendings and residents enjoy PRS (attendings: 5 [4-5], residents: 5 [5-5]). Attendings spent a median of 38 minutes [range 10-90] preparing to lead a session. Resident-attending interaction is increased during PRS compared to conventional clinical didactics (attendings and residents: 5 [4-5]), and PRS permits complementary teaching to clinical rotations and didactics (attendings: 5 [5-5], residents: 5 [4-5]). Both attendings and residents strongly agreed plan review sessions should continue (attendings and residents: 5 [5-5]). Residents preferred reviewing 1-3 cases in greater detail to reviewing more cases with less time per case (4 [4-5]). PRS exposed attending insights that were otherwise unshared (residents: 5 [5-5]). Residents across PGY level strongly agreed that PRS were useful for their learning level (5 [5-5]). Live PRS engaged residents more than pre-recorded virtual sessions (5 [4-5]), but residents were still glad that these sessions were incorporated into the series (4 [4-4]). <h3>Discussion</h3> We successfully implemented longitudinal treatment planning and plan review into clinical didactics. With low burden on attendings and high overall satisfaction among both residents and attendings, this program will continue in the future with incorporated feedback to maximize learning for residents. The program represents an easy method to quickly add in-depth treatment planning and plan review to clinical didactics.