236 - "If You're Talking, I Think You're Muted:" Follow-Up Analysis of Weekly Peer Review Discussion and Deviation Detection after Transitioning from Virtual to In-Person Format

R. T. Hughes¹, J. Prasad², N. Razavian¹, J. D. Ververs¹, A. C. Snavely³, C. L. Nightingale⁴, K. E. Weaver⁴, M. D. Chan⁵, and M. Farris⁵; ¹Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, ²Department of Psychology, Colorado State University College of Natural Sciences, Fort Collins, CO, ³Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, ⁴Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, NC, ⁵Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC

Purpose/Objective(s): We previously identified significantly decreased rates of peer discussion and deviation detection in virtual radiotherapy (RT) peer review (PR) conferences during the COVID-19 pandemic. We performed a follow-up analysis of these outcomes (totaling 5,559 cases across both studies) and surveyed participants before and after transition back to in-person PR at the end of the COVID-19 public health emergency. Materials/

Methods: A prospectively maintained PR database was queried for consecutive cases reviewed before and after the transition from virtual to in-person conferences. Rates of PR discussion and deviation detection were summarized and compared between the virtual and in-person groups. A survey of conference participants’ perceptions and preferences on the format of our weekly PR conference was developed and conducted during virtual PR and after 3 months after the transition to in-person PR.
Results: In total, 2,110 RT plans were reviewed, 1,592 virtually and 518 after the transition back to in-person. 286 cases (13.6%) had at least one PR discussion topic recorded. The most common discussion topics included dose/fractionation (4.6%), normal tissue exposure (3.6%), and target coverage (2.2%). Peer discussion significantly increased after transition from virtual format (no discussion: 90.3%; 1 topic discussed: 8.0%; 2+ topics discussed: 1.7%) to in-person format (no discussion: 74.7%; 1 topic: 15.8%; 2+ topics: 9.5%; p<0.001). There was also a significant increase in the rate of deviation detection from virtual (1.5%) to in-person (3.3%, p=0.016) conferences. Of 35 invited participants (faculty, residents, physicists, dosimetrists, and staff), 31 completed a baseline survey during virtual PR and 28 completed the in-person follow-up survey. Compared to virtual, in-person PR was associated with a significant decrease in perceived distraction (p=0.003). There were no significant differences in perceived level of engagement in, absorption by, or concentration on the conference. During virtual PR, 43% of respondents preferred in-person compared with 52% after 3-months of in-person PR (p=0.529). At both timepoints, most respondents believed that in-person format was best for encouraging PR discussion (61-65%) and detecting/correcting errors (54-58%).
Conclusion: In this follow-up analysis of a longitudinal RT PR database, the transition from virtual to in-person PR resulted in increased rates of peer discussion and deviation detection, and decreased rates of self-reported distraction. These results suggest that an in-person component to PR is important and that efforts should be made to improve discussion and reduce distraction when performing virtual PR.