Forty-one of 46 radiologists (89.1%) who started the intervention completed it. There were no differences between the characteristics of radiologists who completed the program compared to those who did not (data not shown). A complete assessment of characteristics of radiologists who did and did not participate in the survey is reported elsewhere (21
). The demographic characteristics did not differ between radiologists who set goals to reduce their recall rates and those who did not (). The majority of participants were not affiliated with an academic medical center; only one had fellowship training in breast imaging; most had 10 or more years of experience interpreting breast imaging; and most spent at least 20% of their time in breast imaging. The actual recall rates of those who developed goals were not statistically different from those who did.
Radiologist Characteristics* According to Whether or Not Realistic Goals Were Set to Reduce Unnecessary Recall
We also assessed participants' preferences and attitudes toward CME, and determined that the majority (87.2%) preferred instructor-led educational activities, 80% felt CME activities improve interpretive performance, and 88% indicated they would take a free CME course using the Internet (data not shown). No differences were noted for these variables according to whether or not respondents set realistic goals to improve performance.
After viewing their individual indices and the segment of the program illustrating that recall rates above 5–7% do not typically result in more cancer detection, participants were asked if they would consider changing their recall rates and 30 of 41 (73.2%) indicated they would. When asked what goals they would set to reduce their recall, 30 (73.2%) entered a text response in the space provided (). Fifteen of the 30 (50%) radiologists set realistic goals to reduce recall and one (3.3%) set a goal to increase recall. Thirty-one percent (n=5) indicated they planned to change interpretive thresholds, and 25% (n=4) indicated they would re-review of certain images. Nearly 19% (n=3) planned to change interpretive practices, and 12.5% (n=2) planned to seek an independent second review. Unrealistic goals (n=8, 57.1%) typically included a desire to reduce recall without a mechanism to do so.
Radiologists’ Recall Rates and Realistic Goals Set as Part of the Auditing Component of the Tailored Web-based Intervention
We also assessed responses to the breast cancer risk component of the tailored intervention, according to whether or not realistic goals were set to reduce unnecessary recall. No statistically significant differences existed in how radiologists in these two groups consider risk factors when interpreting mammograms at the start of the intervention. This was true for considering age (77% consider among goal setters vs. 78% consider among non-goal setters), breast density (75% among goal setters vs. 44% among non-goal setters), family history (100% among goal setters vs. 94% among non-goal setters) and past breast procedures (58% among goal setters vs. 67% among non-goal setters) as risk factors pre-intervention (data not shown).
Post intervention, when pre-menopausal risk factors were considered, findings were similar in that we found no statistically significant differences between the two groups for the importance of a prior positive mammogram (87% among goal setters vs. 72% among non-goal setters), importance of younger age at menarche (56% among goal setters vs. 32% among non-goal setters), importance of race/ethnicity (80% among goal setters vs. 64% among non-goal setters), importance of higher breast density (100% among goal setters vs. 88% among non-goal setters), importance of family history (100% among goal setters vs. 88% among non-goal setters) and importance of prior benign breast biopsy (94% among goal setters vs. 80% among non-goal setters) as risk factors for premenopausal women. Post-intervention, when radiologists considered risk factors among postmenopausal women, they generally rated them as more important than the same risk factors for premenopausal women, though no significant differences were noted between the two groups (data not shown).
Fifteen radiologists commented on how the use of risk factors should be considered after this module was completed in response to the question: "Is there anything you would do differently as a result of what you have learned?" (). Six (19.4%) of these were radiologists who set reasonable goals for performance as part of the intervention. The majority of the comments indicated radiologists planned to pay more attention to risk factors (9/16, 56.3%). Another two participants (12.5%) planned to pay less attention to risk, three (18.8%) planned no practice change and two more (12.5%) commented to addressing risk in specific situations. Commenting on risk factors does not appear to be associated with setting specific goals for reducing unnecessary recall.
Responses for How Use of Risk Factors May Change Recall Rates As a Result of the Intervention
Prior to the intervention and using a scale where 0=No Change, 5=Work-up Moderately Increased and 10=Work-up Greatly Increased, radiologists who set realistic goals for reducing recall indicated that medical malpractice influences both their recall rates and biopsy recommendations to a greater extent than those who did not set goals to reduce unnecessary recall (). These scores dropped by half after the intervention, and all radiologists correctly indicated that the risk of a mammography related malpractice suit occurring in the next five years was less than 10% among radiologists working full time in breast imaging. Greater than 85% of radiologists commented that at least half of radiologists are concerned that fear about medical malpractice affects how they interpret mammograms ().
Responses to the Medical Malpractice Component of the Tailored Web-based Intervention According to Whether or Not Realistic Goals Were Set to Reduce Unnecessary Recall
All 41 radiologists who completed the intervention commented on concerns radiologists have about malpractice (). Of these, 16 (39.0%) set realistic goals, and of these 15 set goals for reducing unnecessary recall and one set a goal to increase recall. Forty of these comments fell into eight relevant categories including (one was considered not applicable): 1) fear of lawsuits 15/40 (37.5%), 2) media sensation 7/40 (17.5%), 3) media exposure 2/40 (5%), 4) media unspecified 3/40 (8%), 5) impact of hearsay 4/40 (10%), 6) fear unspecified 5/40 (12.5%), 7) fear for patients 1/40 (3%), and 8) fear of professional loss 1/40 (3%).
Responses for How Risk of Medical Malpractice Change Recall Rates As a Result of the Intervention