Impact of structured reporting on developing head and neck ultrasound skills

Abstract

Background Reports of head and neck ultrasound examinations are frequently written by hand as free texts. This is a serious obstacle to the learning process of the modality due to a missing report structure and terminology. Therefore, there is a great inter-observer variability in overall report quality. Aim of the present study was to evaluate the impact of structured reporting on the learning process as indicated by the overall report quality of head and neck ultrasound examinations within medical school education. Methods Following an immersion course on head and neck ultrasound, previously documented images of three common pathologies were handed out to 58 medical students who asked to create both standard free text reports (FTR) and structured reports (SR). A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion and readability by two independent raters (Paired Wilcoxon test, 95% CI). Ratings were assessed for inter-rater reliability (Fleiss’ kappa). Additionally, a questionnaire was utilized to evaluate user satisfaction. Results SRs received significantly better ratings in terms of report completeness (97.7% vs. 53.5%, p < 0.001) regarding all items. In addition, pathologies were described in more detail using SRs (70% vs. 51.1%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 54.4%, p < 0.001). Mean time to complete was significantly lower (79.6 vs. 205.4 s, p < 0.001) and user satisfaction was significantly higher when using SRs (8.5 vs. 4.1, p < 0.001). Also, inter-rater reliability was very high (Fleiss’ kappa 0.93). Conclusions SRs of head and neck ultrasound examinations provide more detailed information with a better readability in a time-saving manner within medical education. Also, medical students may benefit from SRs in their learning process due to the structured approach and standardized terminology.

Evaluation of optimal education level to implement structured reporting into ultrasound training

“…In accordance with the literature, we hypothesized that training effects are marked by acquiring new expertise and skills that consequently affect attitudes, decisions and actions [20,33]. Therefore, improvements in report quality and time efficiency were regarded as indicators of the training process.…”

“…Free text reporting was carried out using a standardized, handwritten template which used to be our department's standard. Structured reporting was performed through a specifically designed online-based software (Smart Reporting GmbH, Munich, Germany, http:// www.smart-reporting.com) for HNU as previously published [19,20,23].…”

“…The implementation of structured reports (SR) into clinical practice has been shown to overcome these obstacles by standardizing the report content and terminology of HNU and other imaging techniques [14][15][16][17][18][19][20][21][22][23][24][25]. On the one hand, the use of SRs decreases the risk of missing key structures and increases the user satisfaction of examining and referring physicians [21,22,[26][27][28][29][30].…”

“…On the one hand, the use of SRs decreases the risk of missing key structures and increases the user satisfaction of examining and referring physicians [21,22,[26][27][28][29][30]. Moreover, the implementation of SRs into clinical training may enhance the learning curve by pointing out relevant anatomical structures, automatically determining clinical classifications and offering correct phrasings [20,24,31]. Taken together, these factors may contribute to higher report quality and comprehensiveness during the modality's training process [4,15,24].…”

“…While different clinical studies were able to demonstrate that the implementation of structured reporting of HNU increases report quality and time efficiency [19,20,23], there is no data at which the level of training SRs should be introduced in order to accomplish the best possible benefit. Even though it may be suggestive that the highest profit can be achieved by the earliest possible implementation, the opposite could be the case.…”