Mac Labs increasing training quality and capacity in the North

Case study summary

The Mac Lab is an innovative method of increasing the quantity and quality of radiologists in training, by creating an archive of training cases drawn from across the North East and North Cumbria, which are used in a simulated workplace reporting environment supported by an expert trainer. The School has expanded its trainee numbers from 55 in 2009 to 70 in 2018.

The idea

To harness technology to improve the number of training places available annually to radiologists and radiographers and improve the quality of training.

The model

There are two aspects of this project:

  1. Introduction of software and hardware to training departments to enable the collection of de-identified high quality cases suitable for training, which are then collated into a central archive
  2. Introduction of academy style learning through Mac Labs using the large central archive

To enable clinical staff to quickly upload any images that would enhance training for radiologists and radiographers, an Apple iMac computer was put into each radiology department in the region. Each iMac was embedded into the individual provider’s IT system. Special software was installed that automatically anonymises the images by removing any patient or organisational identifying details in the imaging and all accompanying patient and organisational data (“metadata”). As a result of being able to do this quickly and easily, an excellent bank of training cases has been built across the region to aid in the training of radiologists and radiographers in image interpretation. The database is categorised and searchable such that dedicated sessional teaching (for example, lung cancer staging) may be delivered.

To increase training capacity an academy style of training has been introduced. The Cancer Alliance is served by two Mac Labs, these are training room equipped with 18 or 24 Apple iMacs. Similar to how pilots are trained on a simulator, an expert trainer (who is a clinician who has been adequately resourced as a trainer) will take learners through a particular topic such as, for instance, staging of lung cancer. From the archive, the learners will see a large volume of high quality cases in a short period of time supported by an expert in the room with them. The archive also includes images of rare or complicated cancer cases that trainees might otherwise have waited a long time to encounter in the hospital environment.

To ensure that work-based training and Mac Lab training remains of a high standard, a three-year quality control cycle is in place.

Early results

  • More trainees in the system
  • Trainees are better trained as exposed to a wider number of cases, including rare cases that they might not otherwise experience
  • North East has improved from seventh best to second best in England based upon the ratio of radiologist per head of population
  • Registras are doing well – their learning is accelerated by the simulation in the Mac Lab
  • Reduction in trainer time required in work-based learning coupled with an increase in Mac Lab time, reducing the impact on consultants work time
  • You can provide high quality training in one day and receive feedback instantly.

Next steps

  • Integrating effective Mac Lab based training into ST4 and ST5 programmes
  • Integrating Mac Lab into the training of radiographers

Quotes:

“An important aspect of the Mac Lab is that not only have the labs enabled us to train more radiologists in image interpretation, but we are training more staff using high quality training and materials.

“The computer software is essential as it enables consultants and staff to quickly and easily upload and anonymise key images. The partnership across the region is important too, as staff from across the region are instrumental in building this excellent quality bank of training images. This is leading to accelerated learning as trainees see very complex and rare cases which, fortunately, they won’t see very often in practice.” Dr Richard Cooper, ex Head of the Northern School of Radiology.

“The Mac Lab and improved image bank is improving the training we provide to staff. It also gives an opportunity to improve training in the future, as we look to maximise the Mac Lab in the training of radiographers. These trainees are funded differently to radiologists, but simulating a range of real-life cases in the Mac Lab would benefit and accelerate their learning too. There are increasing pressures on trainers within the region due to increasing workload and the Mac Lab has enabled us to train more efficiently and comprehensively. This in turn continues to drive improvements in patient care that are at the heart of our efforts.” Dr Alex Self, Consultant Radiologist and Training Programme Director for Quality and Northern Radiology Academy.

From a trainee perspective the Mac Lab has improved radiology training by exposing trainees to a breadth of cases and showing us many abnormal cases in series, which decreases the time required to be exposed to these often rare pathologies. The protected learning environment of the Mac Lab where there are few disruptions and you are able to interact and learn as a group is also extremely beneficial. There is now a vast breadth of pathology in the validated case archive, which has significantly improved trainees ability to prepare for postgraduate exams. The Mac Lab clinical fellow has also been a very well received post in the trainee community, with good opportunities for role development via the post graduate certificate of education that they are enrolled in.” Dr. Amar Chotai, Northern School of Radiology Trainee Representative.

Implementation tips

  • Work out the funding for expert trainers, so that there is a dedicated source of trainers
  • Make space for the training labs
  • Persuade early adopters of the programme to support and champion it to colleagues across the region
  • Recruit a tech-savvy registrar on a part-time basis to help prepare the Lab training model and support consultant trainers.