Evaluation of Departmental Peer Review and Implementation Into Resident Didactics.

Abstract

Peer review is an integral process in the field of radiation oncology to ensure that radiation plans meet appropriate clinical and dosimetric standards. We report a pilot quality assessment of our peer-review process and a model for using the results of this pilot project for resident education. This study prospectively tracked peer review in our department over the course of 9 months and tracked all plans that were not approved. Reasons for the lack of approval were recorded. Plans that did not pass peer review were anonymized and imported to a shared folder for future educational use. Eight cases were used in a mock peer-review didactics session with the residents. The session was led by 2 residents, a dosimetrist, and an attending physician, while the remaining residents were tasked with finding the error or reason for the lack of approval. Presession and postsession surveys were conducted to evaluate the value of the session. Of 2209 total cases presented during peer review, 37 treatment plans (2%) were not approved. The most common reasons for disapproval included contours (24%), dose (22%), and workflow (22%). Breast and skin cases had the highest numbers of not-approved plans, 19% and 16%, respectively. Relative to the total number of cases presented for each disease site, skin had the highest rate of disapproval at 5.4%, followed by gynecologic treatments at 4.3%. All residents found the mock peer-review didactics session to be "helpful" or "very helpful" on the postsession survey and would want additional sessions in the future. Overall, our study showed a low rate of disapproval during peer review, and our resident survey results indicated that a mock peer-review didactics session would be a valuable addition to training.