Results From the Practice Accreditation Resident Reviewer Program (PARRP) Pilot: Educating Radiation Oncology Residents About Practice Accreditation

Introduction: 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 results of the pilot experience. Methods: Participating residents served as junior reviewers with the ACRO accreditation program and completed four cycles of chart review assessing the quality of treatment documentation. During each cycle, residents were paired 1:1 with an experienced reviewer within the accreditation program. Both resident and attending independently reviewed the same set of charts and scored documentation quality using the same rubric. After the chart evaluation, the pairs met to discuss scoring and provide feedback. Residents and attendings were surveyed at the beginning and end of each cycle. Responses were scored using a modified Likert scale ranging from 1 (not at all confident/satisfied) to 7 (very confident/satisfied). Results: A total of three residents and four attending mentors participated in this pilot. Participating residents were PGY-4s at study initiation and PGY-5s at completion. Attendings were disease-site experts with >2 years of practice-accreditation review experience. Across the four cycles of chart review, residents reviewed a total of 15-16 charts (3-4 charts per cycle). The median length of resident-mentor feedback meetings ranged from 31 to 60 min. Residents’ confidence in their chart-review abilities increased with each cycle of chart review as follows: pre-cycle confidence increased from a mean of 3 (range: 2-4) in cycle one to a mean of 5.3 (range: 5-7) in cycle four; while post-cycle confidence increased from a mean of 4 (range: 4-5) in cycle one to a score of 6 for all participants in cycle four. Residents’ perceived need for additional cycles of chart review decreased over time - from 100% in cycles one and two, to 0% in cycle four. Resident confidence in independent documentation review increased with completion of the program as follows: from pre-pilot mean of 1.7 (range: 1-2) to post-pilot mean of 6.7 (range: 6-7). Conclusions: In this pilot study, we demonstrated that mentored chart review can improve resident confidence in practice accreditation. Resident confidence appeared to peak after four cycles of chart review. Structured mentorship programs such as the Practice Accreditation Resident Reviewer Program (PARRP) may help supplement radiation oncology education in patient safety and quality improvement.