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All right, let's let's go. Um So welcome this evening um to this event. Um Candy already. And um I'm the team lead for um Radiology Interest Group, Africa. It's my pleasure to welcome you. I'm on this platform today. Um So this is an interest group for African medical professionals. We have an interest in doing radiology as a specialty. It's open to medical students, um junior doctors, um those who are in training and even consultant. Um We're interested in specialty. We hope to support each other in our career aspirations and help open up the opportunities. Um If people have interest in, I'm collaborating um internationally. Also, we also trying to put create um a bank more resources um where people can go to um if they have interest in um exploring topical issues in the specialty. Um A lot of us here are familiar with the concept of the clinical, of clinical audits, especially if we have um probably apply to jobs in the N H S or working in the N H S. Um We've come across it as a quality improvement program or project that um sort of compares clinical practice in our different centers with um national guidelines, like the nice guidelines. Um The speaker today is Dr IgE Way is a second year radiology specialty register uh um the All University teaching Hospital. And earlier today, we're having a chat about how he took the scenic route into radiology and how he's enjoying it now. And I'm sure there are number of us who are looking to um applying to the specialty um training, maybe this year in the next two years. I'm sure we can pick one or two things um about how to do audits, which we can include in our portfolio or even if we have the opportunity to present internationally uh conferences and also um in publications. Um the, the just as a rough idea of our, the agenda to this program. After after this introduction, the, the speaker is going to come give us a presentation if we have questions um during the uh the presentation, just to make sure you put them into the chat box as they come up after the presentation will give opportunities um for um interactive session with um the speaker where we can, where you can engage, engage an answer. Um As many questions as we were able to cover, I'm following the, the answering questions. Um The in an answer session, we're going to have the short announcement from our educational lied about the research boot camp. We are organizing as part of our programs um this year to help people engage in radiology research. Um This will be open to our members, but she'll be able to give more details as this goes on. Um We would also um like and appreciate um your engagement with feedback from this event. So we can uh we can improve on future events and yeah, just get to know more about your pinpoint or things you would want to learn from this interest group. So shortly I'll be leaving the stage. Um, so the speaker can come in and present, make the presentation. Hello, Dr Gray High, high high came into for the introduction. Good evening everyone. Uh I'm just going to try and share my, uh my screen and I hope everyone can hear me. Uh Can, they can just give me feedback if everyone is hearing me and if they're happy for me to proceed, I can leave louder, clear uh effect. I'll just share my screen. Um, have the slides come up now. Yes. Uh Okay. Uh Giving everyone, uh Thank you for the introduction getting there. Um You know, like I told him earlier, I, I serendipitously stumbled upon radiology. Uh when I came to the UK, initially, I, I plan to do medicine and wanted to be a cardiologist or oncologist. But, you know, things happened in between and I decided to do with all against Ed and, you know, like you said, I'm not regretting it at all. In fact, I'm actually really enjoying it. Um he asked me to present this uh topic which is conducting with clinical audit and radiology, um which is a very important topic in healthcare in general, really not just radiology. Um Again, um I'll just do a very short presentation over the next half an hour. And then you guys can ask me questions and um we can be able to obviously talking about portfolio building radiology or just special to training the UK. Generally, I can take it from there. Uh What we are learning objectives today, essentially, we'll be looking at what are essentially the purpose and benefits of re a logical inc audits. Why are we doing it? Why is important and how does this actually benefit patient? And most importantly, how is it necessary are all important for your C V? Because essentially that's why all of us are amazing. Um And I want to know the key steps involved in conducting an audit. We want to know the types of audits that are available in radiology, want to know what are the best practices and what are the potential challenges in conducted an audit? Whether you're in the N H S, you're working in the UK. But you know, in the N H S or whether you're overseas, maybe you're in Nigeria or in the other countries as well. And then obviously just look at some case studies and some examples from my own personal experience from colleagues. Um and obviously from the internet as well. I tend to describe radiology, uh the rule of Realogy and healthcare generally as a lighthouse. So obviously, you can look at the light house, you can look at the waves of the, you know, of the sea and you can look at the ship. Um I think I described it as a radiologist can be compared to a lighthouse, you know, is guiding and overseeing the safe passage of ships. And essentially um the ship is the patient. Um and the vast ocean that you're seeing is sort of the current healthcare that we have at the minute because healthcare is very turbulent, is very complex, is very difficult and you know, uh to navigate. So, radiology sort of provide those critical information that will help the patient safely navigate uh true healthcare. And how does that relate to clinical audit in the context of clinical audit? You know, the lighthouse symbolizes the radiologist vital, really maintain and improving the quality of care. So just as a lighthouse, obviously, you know, must be regularly maintained and updated to service purpose, effectively, radiologist must also participate in clinical audits to ensure their practice remains up to date, you know, their practices efficient and it's obviously in line with established standards as well. So essentially the clinical audit process will help to identify areas of improvement and audit is essentially one of the backbones of clinical radiology and you know, radiologists at the forefront of uh of of clinical audits in healthcare. How does this relate to portfolio building? Because essentially if you're trying to apply for a specialty out of your, applying for radiology or you're applying for any other specialty, um The you have to build up your portfolio. Unfortunately, it is difficult uh and very important as well. But the most important thing I always tell people is that you have to look at the portfolios, current character. You have to have this sort of made up table about the portrayals current criteria somewhere, you know, in your bed or your living room anywhere. And you have to make sure that you sort of highlight those key areas and ask yourself how can I score those maximum points? And essentially, these are no questions. You'll be asking yourself two or three months before the the application process open. These are, these are things that should be asking yourself, you know, a year or two down the line before you want to apply because you want to give yourself enough time to be able to get as much maximum points as possible. However, from my own experience, I decided to apply for radiology a week before the application closed. So, and I managed to get some points. So I suppose if you already applying setting principles such as if you're really doing audits also form of quality improvement or if you've had some previous academic achievements or some previous prices and awards or you already in teaching you probably score in some points. But the quick, the earlier you sort of um tease out those important things that you need, the more you can achieve, make all those maximum point. Uh I think this was last year's portfolio scoring criteria uh for this year's uh in communist the ones. And if you look, you know, it's very difficult for you to score some of these uh top marks. I'll just elected the one for audit and quality improvement because that's what we're talking about today. But it carries about seven point if you get the maximum points. And what does it take for you to get the maximum points you have to have led to a more audit by it's really to radiology and I've shown, you know, that this has changed practice, so seven points, a lot of points. So audit is important in terms of your portfolio. So, unfortunately, you have to do them at the end of the day. Again, people are gonna ask, you know, this is difficult. I'm not sure I can be able to do this. But actually if you look into the nitty gritty, it's not as difficult, you know, uh as people make it out to be leading a project doesn't mean that you have to do everything essentially means someone has played a major role. Either you've played a major in conception, either you've played a major in data collection, either you've played a major in date analysis or if someone did these things and asked you to present it, that's essentially you leading the project. Have you changed practice? Doesn't necessarily mean that you've done something big. And the chief execs for the hospital have actually spoken to you about it. Essentially changing practice simply means that there's been a difference. Okay. If something increases from 70 to 90% that's a change in practice. Um, if something leads to better compliance in one way or another, that's a, that's a change in practice and research. Radiology simply means that honestly anecdotally, I think 60 70% of audits is are in some way related to radiology because you know, people are gonna talk about investigations, people are going to talk about processes. Most of these have some from, you know, of, you know, uh inclination to radiology. So, you know, the long and short of it is you can score the maximum points in audit and quality improvement. Um and, but then it requires a bit of time and then the maximum points is calling quality audit and quality improvement can actually help you score reasonably good point when you obviously go onto uh prices and awards because you can obviously present those awards in radiology meeting. And obviously you might be able to score some of those six points as well. So essentially doing well in all, some quality improvement can N U maximum points in uh in sort of two out of uh sort of uh seven domains. Um So, yes, it's very important and I think you should sort of, uh and it's good that obviously everyone is here to sort of uh learn a bit more about audits. Um Again, what, what's clinical audit and why are we doing it? Um And then click all these times from quality improvement and healthcare, which is essentially a systematic use of methods to improve quality of care, which would provide patient and obviously ultimately um improved patient outcomes. And again, people obviously confuse the outcome of what is a Q I and what is a clinical audit essentially? I think they are similar. However, clinical audit is sort of a an initiative or an essential component of, you know, the broader concept of quality improvement. And you know, it, you know, it gives us a good insight of what current practices is like, it measures effectiveness against an agreed or proven standards for high quality because essentially seizure people miss was an audit and what is a clinical research. And as we talked about in types of audits, uh sometimes people confuse a retrospective audit with a retrospective study, you know, which is essentially a clinical research and audit needs to have an agreed of proven standard for high quality. There should be a bar that people should or an institution or a group of um you know, a group of people need to obviously be aspiring to in terms of, you know, the process of, of, of healthcare delivery, the outcome for patient's and obviously, whatever you're doing is that you're measuring um whether these standards are being met essentially and then you're finding ways for you to be able to improve them again. In initial problems I had initially was I find it very difficult to differentiate between clinical research. Um an audit which essentially meant that I spend time designing a clinical research instead of just doing a simple audit. And I know a lot of who were saying that it, you understand data analysis and all that. I think if you're talking about the to analysis, you're almost certainly going into clinical research and all that doesn't require you to download S P S S or the big Softwares to do analysis and what it simply requires actually calculator or an egg soc. It, that's it and you can get an audit done. So if you keep thinking about it or something big or, you know, like a big research project, then obviously, you know, you're, you know, you know, setting yourself up for, you know, for a bit of a disappointment because you need to be able to make it very simple. That's the way you can be able to deliver it okay. Um And again, this is just leading up to the sister dimensional quality framework because obviously, like you said, audit essentially tends tries to measure and ensure that this quality framework is being followed in healthcare So how do you do an audit? What's the audit cycle? Like you want to, first of all identify that there's a problem. Um, and then if you identify there's a problem, then you have to come up with methods to be able to address the problem. And for each I'd entire problem, you need to know that something is a problem if they're setting standards that have been set to address that problem. So essentially if you're doing a clinical audit, you're not coming up with anything new. If you're coming up with something new, that's a research. So clean code, it means that someone has studied something or someone has obviously established a certain standards and say that this is the standard that we should be meeting for, you know, something in healthcare. And essentially what you're trying to do is to find a way to measure and see whether either in the institution that you're working, either in the water, you're working, either if you're working in theaters or if you're working in the lab anyway, you're working, you want to be able to identify whether you're actually meeting you or your team actually meeting the standards. Obviously, when you're the insider, then obviously can talk about the methods, then obviously can go on to analyze that what you found and comparing it to the standards. And then you can obviously think about an action plan on how you can use to get some changes. And then you need to do a bit of monitoring and then you can do another reaud it so they can be able to close the close the loop. And essentially this is a very nice summary from our CGP that obviously sort of set up the entire journey to do a clinical audit. Obviously, you can't do an audit without choosing a topic. But like I will come to in a minute, choosing the topic is one thing I think the most important step in doing a clean code is finding vegetable supervise or mentor or someone that can be able to guide you through the steps. Once you, once you're able to do that, then you can treat the topic, then you can set a standard, then you can collect your data, then you can analyze your data, then you can implement some changes. And obviously when you implement change, you need to give it a bit of time. So given change time can mean one week, one month, two years, three years. So you need to be able to, when you're selecting an audit topic, you need to ask yourself, I want to close this audit because remember for you to get maximum points in the portfolio you need to do to close audit. You need to ask yourself this weight for changed cause effect. How long is it gonna take or how long am I gonna be here? If you're gonna be okay in the hospital for over two years, you'll be a bit more relaxed because you say, well, I can do an audit that I can collect data over a week or two and then I can get some changes that will take six months to work and then I can reorder it for another six months. So obviously over sort of a 12 month period, you have your results. But if you're rotating from departments of after four months, you can't be doing that kind of an audit. So you need to be able to see the end from the beginning because or you know, if you have someone that works in the department that can be able to carry on the audit and make sure they put your name in the real date, then that's fine, that can probably work. So you need to obviously factor in where you are, what sort of environment you are in for you before you're able to choose a good topic. Um And again, these are just things I highlight that from the internet and it can really top if you want. I probably wouldn't, but essentially highlight sort of why we're doing clinic auditing radiology, what's appropriate in terms of clinical audit and where you can obviously get more information if you want to read up on clinical audits, um as well, essentially, you know, enhancing patient care, improving safety, departmental efficiency, professional development, essentially what we're actually looking at or why most of us are here is for this professional development. That's what we'll get you those maximum points in your portfolio and that's what might be able to get you a training number um in radiology or in a specialty that you want to do as well. What are the types of audits? We talk about prospective vessels, retrospective audits? Like I said, people tend to confuse retrospective audits with research. They are not really the same, like, you know, we've alluded to the, you know, prospective or retrospective of this, they're not mutually exclusive. Sometimes they actually coexist together. For example, um you're trying to audit um you know, is of uh for, you know, foreign marker, for example, on, on a chest radiograph, for example, or use a foreign uh object marker in terms of foreign object detection, in sort of normal plain radiography, essentially, you can do a bit of a retrospective study over the last three months, check what the compliance is like in the hospital. And then when you do that and you cannot do a perspective after you've put in some, some actions or whether you've done some, you know, some um um what I've implemented some changes and then you can do a perspective um as well. Um And then obviously another important distinction is between the process and an outcome odd. It essentially a process order to uh evaluate workflow and procedures. Essentially for an example, if you're looking at consent in interventional radiology, you want to check whether everyone that comes in for an interventional radiology procedure have consent and ideally it should be 100% that should be the target. So essentially evaluating, you know, workflow, you're evaluating the process. You know, you want to make sure every patient has consent. If they have informed consent, if they can't give informed consent, do they have a different sort of form of consent? Um that covers for them example, from your relative or, or from soda has a power of attorney, for example, again, you know, that's a process audit. And then if you're looking at an outcome audit, for example, if um the RCR recommends that, you know, see TPS for pe that you know, the diagnostic yield for P issue or 15%. So you want to make sure that all the CT P S that are requested in the hospital have at least a diagnostic it of about 15%. So you're looking at an outcome audit, their, you know, you want to make sure that these resources are not being wasted and obviously you want to make sure they're effective for patient's care. So the most important thing is that you need to find out what are the common radiologic audit topics. This was the first recipe uh in in radiology uh in terms of clinical audits and it was over 100 recipes. Um Again, this has been modified a lot and the newer version of this is what you see as audit life in the R C our website, which I'll come to uh in a bit. Um And again, it has lots of topics. Essentially, these are things that have been curated by members of fellows of the Royal College. And they give you sort of a topic and they give you standards and they give you methods and you just have to just go ahead and just implemented it in where you work and can come up with uh an audit star way. And this is very nice uh sort of uh stratification of types of audits based on location. And I got this from getting to radiology website. Very good reasons. Essentially, if you're in an emergency department, the type of audit you should be doing is different. If your emergency department, you don't want to go and be checking compliance of GPS with um two week, wait CT pancreas requests, you're not going to be able to do it because you don't work there. You don't know. The challenge is how can you come up with the national plan? Who are you going to talk to the consultants? And the, and your seniors will not be interested in topic. So you need to able to kind of find specific topics that based on where you work showing the world their world based audits. If you're in the community there, committee based audit, and if you manage to get a radiology test a week, there are sort of audits that you can start on the test a week. There's audits, they can sit on a Monday when it's like a test a week, essentially by Friday. When you're done, we'll test a week. You already have a close look audit at that time. So these are some things like things that you need to plan, you know, ahead of time, you know, to get done. So, I, I think of clinical auditing this way um on the, on the left, on my right, I'm not sure that's Hayley characters. She's a long distance runner, fantastic athlete. This was her in London Marathon, 1019 and essentially she's made it to this finish line. We could see that she's struggling a bit to cross that finish line. Um Again, you can perform what it that way. Okay. But ideally you need to perform an audit like using boat, you need to start it quick and finish it quick and then move on to the next one. The more you, you know, you spend time in an audit, the more it drags, the more you can finish it, the more you're putting a lot of effort in and you're not seeing optimal results. So essentially you want to do audits like uh like uh you send boat really? What are those key steps in conduction? All of that you want to find a supervisor or mental? I think this is the most important step in doing an audit, if you have someone that's twisted in the topic, if you have a consultant or even the radiology training already, that's a senior trainee that is interested in the topic that audit will finish when we're another because they need it for something. Um, so these are kind of audits that you should be doing audits that given to you by someone else because those audits are the ones that you can finish quicker. Those are the audits that have bigger impact in the department. Those are the audits that tend to win awards. And typically every radiology department I know in this country have an audit lead or clinical audit lead, they do have national audits lying around, they do have audit topics lying around that needs to be done or an audit trainee did and then they left it that needs finishing and the audit department is looking for someone to finish it, speaking to them is always a good way to no, someone that is, you know, is well versed in clinical at it, getting a good topic and having something's already set out in stone that you can be able to do. I think this is the most important step in doing a plane called it. I I will not advise going to look for a topic yourself. However, obviously that can happen if um you can't find someone that can help you to do it, you can find a topic and obviously find is provided your mentor as well and say, well, I have this topic, I want to do this audit. How, you know, how, how can I go about doing this as well? Again, once you identify the audit topic, you have to set your objectives, you have to get your objective, you have to, you know, set your timeline, define what you want to do, define how long you want to do it for. Don't push it too hard. That's what, that's what something pretend to do, which can be a bit of a problem. And I did it a lot when I set an audit where I wasn't quite sure what I was doing. Um I felt I could do it better collection in one day, but I couldn't or, you know, essentially you're going to try and make things a little, a lot difficult for yourself. Um So the next thing you really need to do is you have to define your standards and your criteria. Again, you're looking for topics that have standards established. You're looking for topics that people know the standards because that's the only way you can, you can implement a good change if you put on all the standards and you have to explain the standards to them, they don't actually know what to improve on. So essentially you can close uh to look, you know, remember what we said, what you're looking for is you want to see something go from 10 to 20%. You want to see something go from 70 to 90%. You want to see something go from 70 to 95%. That's it. That's what you're trying to do. So you need to find standards and criterias that are measurable. You need to find standards and criteria that people are. Well, so that when you're improving those changes, they can actually see it, um, as well. And again, this is really, really important, especially if you're working in the NHS, you can't really do an audit without registering with the audit department. I think it's a waste of time and I think you're basically setting yourself up for failure because the IUD department is essentially your friend. You know, they will chase you if you don't meet up with a timeline, which is obviously not a good thing. But if you're able to do a closer product, you get a certificate from that and that's what it is really important. That's really evidence that you need and to follow you forever wherever you go. Um You know, and if you meet up the time, you know, if you meet up with, you know, and they can actually provide support and help you if you, if you're stuck or if you need to speak to people to be able to get some changes done, especially if the audit. Lee feels that this is an audit that is really important for the department or for the hospital. Um so always try and get it registered is quick and easy to get registered and always try and create a reasonable timeline as well and then collect and analyze your data. A simple Excel shit is fine. Um Most time if you speak to the uh the department there, there's always someone in the department that can do the initial data instruction for you and put the, you know, the initial patient details that you need them in the sulfa. All you have to do is to, you know, go to the, you know, if you're working in radiology or if you have access to radiology system, the Park system, for example, you can be able to pull uh you know, some of the data that you need or anywhere you're working from the electronic medical records, you can be able to put the data that you need. And that's it. You compare your results with the standards and the criteria is he being met? Is it not being meant if he's not been meant? What are the reasons why it's not being met? Do people need more education? Do staff in the bit of change in terms of how these sittings just, you know, that's it just have to formulate a national plan in terms of what you need to do, duty to present the audit somewhere to be able to, you know, get people know that we're not meeting on this criteria. Um And that's it again, you give a bit of time and then you rewarded to evaluate the impact of the changes. You see, it's not that difficult. I think we tend to make of it a lot difficult. And it is essentially obviously, if you have someone that can give you a topic, what do you do? You have to go look, searching for a topic somewhere. I think there are two main big resources. I always tell people. The first is if you're thinking of something radiology related, I can almost guarantee you that so on. I thought about it before and you might be lucky. And you see a template here in audit life, which is available for everyone uh in the R C our website, it's always good search check for an audit template. Even if your topic is slightly different, you can always modify it because essentially in audit life, they give you a template. You know, there's already a background, there's already a title, there's already methods, there's already standards set. Essentially some of them even have the data collection shit already. So the the entire job is done for you. All you just have to do is to register the audit color your data and that's it. You're done and there are some of them, you will have action plans in terms of what you need to do next as well. So audit life is really important and you can find very nice topics uh there as well. Just a bit of highlights in terms of what defining on standards and criteria is essentially some of it. You can't, you don't have a specific standard or criteria. Again, you shouldn't be doing this alone, should be speaking to someone or there should be a superior, some senior or your own, of your consult on that and they would help you with this. Um And you have to reference established guidelines. You know, you have to determine whether this criteria is immeasurable. You have to make sure that the targets are achievable. You can't tell people to, uh if you request a CT pa, you have to make sure that 50% of the time, you know, it's gonna be positive for pe that's not possible. That's not what the guidelines say and it's not really measurable anyway. So essentially, that's not something people can fulfill. So essentially have to work within the confines of what established guidelines are. Anything you're doing outside of that is no longer an audit is almost been a research essentially. And again, if you find the criteria, you have to ask yourself what is specific in terms of my department, what does this department need and how can I help this get better? Is this a hot topic that people are talking about? Obviously, you know, if you're working in the NHS during COVID, literally most auditory about COVID and COVID and COVID and COVID. So essentially have to look at the context and see, you know, what's the hot topic in where you work? What's the hot topic nationally? And then can be able to make sure that you're choosing your topic that is, you know, reference to that. And then data analysis and collection again is quite straightforward. Just good Excel spreadsheet, create a good Excel spreadsheet. Once you verify audit and you're ready to go try and collect at least four or five, for example, 45 patient's and see whether is a spreadsheet. Um intuitive is this pilot spreadsheet good, doesn't need modification. You know, you can access, it won't help you and just see whether discretion is a bit of modification. But if you choose a good topic and you choose a good audit template, then you already know what needs to be in your spreadsheet. You don't have to go back and forth looking for more data as well. Obviously have to remember that data privacy is really important, especially if you work in the NHS and you get so you have to be careful in terms of where you store your data, you know, creating a good um creating an account both means to put them obviously um have an account in terms of the hospital system where to obviously keep their spreadsheet. Um as well. Obviously, when you do a data collection analysis, you have to visit from later National Plan um subsequently before you do your, your re audit. And again, obviously from there is the audit to, have you identified the gaps? Have you identified areas of improvement? You know, have you assessed progress? Have you done your audio audit? What's your plan in terms of dissemination? Is there an upcoming conference that you can present it in? You know, is the uh, an audit meeting that happens in the department regularly where you can present it in? Is there like a monthly meeting that happens that you can just ask a consultant for a 10 minute slot, a 15 minute slot present your audit. These are the opportunities that you should be looking, looking out for. Because once you do this, you've done the sort of part of the action plan and you're looking forward to do a real audit to be able to close the loop. Remember, not all audits are positive audit, you can actually do a real audit under standards have dropped, just simply means that there's something wrong than it's fixing. So you don't have to present audit where things improved on the year. You can also prevent present audits where things are not improving or things are static. Again, it's about continuous improvement and identification of gaps and areas of improvement. What are some of the pairs and pete walls? Essentially, almost everyone has to do audits and in terms of things that almost everyone has to do, actually, you know, too many cooks supposed to broad. Um this create a bit of a problem and actually I found this very interesting, actually, um, it was an audit that was auditing orthopedic audits and actually found out that, you know, out of over 25 audits that were performed, you know, only 20% of all this completed what it cycle and only two were against national standards and 28% almost a third of the audit was not based on any standards at all. Essentially, we're not really doing any audits and he could look at just, just 30% of others that are led by junior doctors, like most of us actually resulted in implementation of the action plan. However, if it's a consultant led audit down on back goes up 75% and actually even know state audits, the number is about 67% who is over double of what we get as junior doctors. So it's really important that you involved this key stakeholders early, you need to find a reason why someone above you or someone that is working permanently on that particular award or theater, for example, like a nurse or radiograph for wants to get that all be done. Once you give them a reason why it needs to be done, then you know, that you probably get, you know, have an audit that you can finish, you know, so essentially try and avoid, you know, projects that they clearly defined objective. While endgame inside, you need to ask yourself this audit I'm doing. Where am I going? To present it. What's the plan? You need to know the end from the beginning again, you need to stop picking up loyal and higher foot projects. You don't want to do an audit of 1000 patients'. That's a lot, you know, that's a lot and it's, you might run into a lot of problems doing it. So you need to pick and choose, you know, so it's not really quite wise to say. yes, yes, yes. Every project, if you see a good project that have a good team that you have a well defined protocol, yes, get yourself in it because obviously, you know that because of the team and sort of because of a well defined pathway, most likely this will yield fruit. So it's gonna be a high you'd project and essentially may be what they would tell you to do is, oh, just collect data for 50 patient's and you get your name on the audit and you know, we're gonna publish the audit anyway. So those are the things that you need to try and look out for um as well. And it's not going to take you a lot of time for you to be able to do that. Again, like I said, lack of cinnamon but is really important. Um And again, you need to know how to monitor improvement. You need to be able, like I said, you need to find the criteria is measurable. What can you measure from beginning to end, this is why survey audits tend to work a lot because once you give someone a survey before you can survey something after and if you do that, you already have some form of um um you know, improvement and you can obviously use that. So we have to look at some examples and some case studies and just carrying on from the last slide, like I said, you know, you need to be aware of the, the sort of audit that you're picking because that would essentially mean that, you know, you can be able to finish or not. So I looked at some of the, you know, available resources and this very nice article in, you know, in Asia about audit for Georgie trainees is really cool because even as really register us, we have to do audits. But yeah, you need one audit per year of training and if you're doing a five year training program, so you need to have done five audits, you know, by the end of your program and most of the time, a lot of trainees are just doing it to be able to take it as part of their portfolio. They have other stress and other things they're dealing with, you know, on calls exams and all that. And typically why are they applying for ecologies? If you find the radiology with the Strattera is in an audit, you can always collaborate to them because again, there's something you need for them, they need to finish audit for the ERCP, they need to get this audit done, you know, for them to progress to the next year. And if you obviously obviously help and get things done or if you really take the lead and they're happy to be second. Uh, who cares? You know, essentially they get satisfied because, you know, the audit is the audit tick boxes done for the year and you get yourself a good audit. That is probably gonna be a close look from someone that's in the department and know some of the key stakeholders as well. So I think, you know, collaborating with the auditory and is where you work because again, you're seeing them, you know, how to contact them. You guys have the same system, that's a very, very good wealth getting audits done. Um Again, these are some of the topics I picked up from audit live. Again, these are audits that if you know someone that has something to do with some of these topics, then it's an easy and a quick audit to do. Um And obviously these are things that you should obviously be looking out for wherever you work. I'm just giving a sample of this is uh one of the oddest I did and I did it too. It's a wonder, actually got a radiology training number this year. Uh Again, it's similar thing, you know, if someone I came for a test a week and we had a chat and I said, well, I need to get an audit done and you clearly need a project to get done as well for you to be able to apply for radiology as well. And essentially we looked at this topic from audit life, you know, appropriateness of CT P investigation for suspected e essentially it's a common topic. We knew it probably has been done before. We just have to find a good pain for it to be able to do the reality. And there's a very nice template for it already on audit live. So it was an easy one to register for already. So essentially, we looked at the background which we know about, we looked at the cycle. So there are three standards. Um Essentially, we just want to make sure that, you know, the referrals for CT PA studies are in line with sort of local protocol. And if you look at the hospital intranet system, there is a local protocol for, for requesting CT PA, we want to make sure that the diagnostic you'd for CT P A is meeting published studies. Again, we don't have to look for it because this audit, um what document has given us all the numbers that we need. Essentially that, you know, diagnostic, you should at least 15% and an alternative diagnosis should be seen in at least sort of 50%. And the target for number one and two is about 100% each. Um And obviously, that's target for number three. And what are the indicators is the an existing local protocol? Um Are they referring leaders available for patient's with the on the N C T B A? Of course? And can you find the percentage of patient's that have confirmed P E alternative diagnosis or neuroradiology uh or no abnormal local diagnosis? Yes, of course, you can because these things are available as patient's report in the radiology system and the hospital medical records as well. And then they actually tell you the data that you need to collect. It can be that easy. So you just need to collect this data and you have your audit done essentially and he actually suggest the number. So you can just collect 50 depending on the size of your department, you can just collect 50 conservative patient's and then you can actually actually suggested actually possible Axion plans that you need to do for it to able to meet those targets um as well. So once we picked up our topic, we realized actually someone has done it before. Uh one has presented it before and actually was a closed audit. So we're like, well, OK, so what's the point of doing this again? If someone has done it before, then I spoke to the audit lead in the department and she said, well, this is old now, this was PRE COVID that Riyadh it was done she wants another audit to make sure that this compliance has not changed. Now, sort of two or three years down the line. So that's even a bigger blessing because now we have a topic that's been done before. You know, we have this topic, this has been presented in B I R before one of the presenters there. Matt is still a registrar here. So I know him very well. I have access to whatever they have done before. All I just simply need to do is to collect some more data and that's it. I've done another re audit. I've done another loop of the audit essentially. And I can present those three sort of separate um um loops and again, it forms a good, you know, Q I project or whatever. So, and then obviously, he helps me in terms of my progression as a registrar and the person I was working with essentially, he becomes the first auto, he can present it as a national presentation. He gets full mark for that and that's a full close look audit for him that he can get signed off by the audit league of the department. Eventually we get it all registered. Like I said again, it's simple in our hospital, they email you this form when you just email them, you know, you have to obviously, you know, put in the title of the project wash of timescale. Always put reasonable timescale. You don't want to put a very short timescale, you want to put a timescale I can meet up with. So typically I will say for some projects, I put six months, even if I know that actually I'm going to do the audit in about two weeks or probably six months. All you don't want is the audit department emailing you after two weeks to ask you how far you know what's up. So you need to be able to give yourself that time. Um And again, asked about what your verrucous of the audits. Essentially, it's a copy and paste. We know the purpose because temperatures given us a purpose, we know the background because you're the temperature give us a background, we know what the objectives are because temperature give us an objective. We know what the standards, how the guidelines are. You know, we're not looking for anything, we know what these answers are. So we'll fill this out in 10, 15 minutes. And, you know, this is just a slide from the presentation that we did in the department. You know, just essentially we identified the problem which has been identified by someone before and which was to compare the appropriateness of CT P request against National Guidance, you know, and the method was to do the collection of all CTP request in the time period. We have to collect the variables when they analyze the data. What compared to National guidelines, identify areas of improvement. We want to make some changes and the initial change that was made was in traditional mandatory requirement from clinicians and essentially just introducing this change, you know, significantly improved, uh you know, appropriateness of the request essentially and again, monitor. So essentially, this is where our current audit, you know, came in because essentially we're trying, we're trying to make sure that whatever has been done before is still being followed. And it's just to other areas of improvement as well. Um And then this is just a summary of what we did essentially. So obviously, they did the October to November 1017 they looked at um sort of that was initial audit, pilot audit. Um This was done like a year after. Um and then in June was the re audit. And then obviously in May was sort of, uh this was the follow up body that we did um subsequently. And again, that was presented in S R T uh as you know, he was first the presenter and, you know, and I'm sure he, you know, he scored full marks uh for the audit presentation. Um Again, this was an audit that I did when I was a medical trainee. And again, it was when I was doing my I T U posting. Again, I was looking for something quick, nice, easy, good hot topic. And essentially I had a chat with one of the consultants, diabetes consultants that used to come and review I T U patient's during COVID and essentially was more like, okay, I'm looking for a topic to do. So we look to said, okay, glycemic control in COVID 19 patient I T U setting is a big problem. And actually there's a new guideline which she wrote um and asked, well, can I do this audit essentially? So all I had to do was just fine it consultant in I T U. That was really nice like that can obviously help. Um And then we looked at just, you know, between seven ICU patient's with COVID that was treated with dexamethasone. Uh And the good thing about this was I did the collection with my colleague, you know, we did a presentation in the I T U meeting again I T U, they do meetings every day. So there was definitely an opportunity for me to present it. I was looking for an opportunity presented locally. So that was presented locally and then I registered for the diabetes UK meeting 1,000,021. And if you use it for the meeting to present your audit, all the audit abstracts going to diabetic medicine, which is their uh their their journal. So essentially from doing this audit, that was quite straightforward and simple to do a manage to get an audit presentation for it, a managed present that they national sort of uh meeting as just a poster anyway. And obviously, there's a journal publication of the abstract somewhere which obviously helps you in terms of, you know, your publication as well. So these are the things that you need to be, you know, looking out for. Again, I know another of us work in the NHS and some of us are working from overseas. Can you perform a good clinical audit from overseas? The answer is yes, this is an audit uh that was performed in Wellington Hospital, Abuja about uh my close friend can uh and essentially was audit of management of tracking ized brain injured patient uh in a surgical hospital. Again, this is a very nice audit, you know, straightforward uh reduce spatial analysis of 24 patient's. Um Again, you know, very easy methodology. The consultants were keen to get the audit done and he managed to, you know, get good results out of it essentially. And he led to an award, it was the best um oversee training, led research or training in an ent conference last year. Obviously, you know, the guy that did the audit um the one in the middle. Um So yes, you can still do a good audit from overseas as well. And then I picked out some of the slides from ASA in terms of the winning audit um uh posters as well. Essentially, these are posters, these some of the audit topics are not something that you think will win the price, but what you need to look at is what sort of impact does it have in terms of you know, the process in terms of, you know, patient outcomes. And what is the methodology? Again, this is a very, very, very simple thing that you can introduce and actually make huge impact for patient care. And most of the time these audits are something that a consultant or a trainee have talked about and you're involving consultant and if you have a departmental input, it can actually have a bigger and wider impact. Um as well. I found this, you know, post really interesting as well, mainly because of the fact that, you know, the audit targets, we are locally agreed and it was something that can easily be introduced and it's something that can easily be sort of followed up because you're giving your giving user feedback before and after. So you, you're expecting sort of a huge change essentially. Um And again, like I said, people talk about the analysis. There's nothing difficult in doing these analysis. All you have to do is to create some tables in Excel and it gives you some very nice graphs and you can do a presentation on it. Again, this was a very another fantastic audit from U C L H. Um While I found this one interesting, again, this was the winner of the R C R E Poster competition in 1021 was it was trying to evaluate the service area in terms of acute report. And um and then obviously want to do work full analysis essentially in terms of the entire audit, you know, the first cycle was performed in nine days and the second cycle was performed across five days essentially. So, in less than a month, you've done an audit that was able to win an R C O E poster competition. I'm sure some other people spend more time doing audits, you know, spend more time doing their own orders. But I'm shredding with this award. So it's all about finding those low hanging fruits, finding those good topics that can make a good change people are interested in and obviously working on it. Again, that's a very nice audit even from last year. Again, this is more specific and again, these are the kind of modest people are looking, are looking for and these are the kind of audits that a training will not think about. These are kind of audits that typically come from a consultant or a training can pick up from audit life and then try and obviously um um uh but then you still need a huge consultant impute in terms of actually trying to um um sort of get his audits over the line again. So in summary, you have to choose the right topic. Um you have to find this provider mental. You have to make sure you get audit registered and essentially that you have to find idea low hanging fruit. Is there something that someone wants to be finished? And I can be a presenter. Is there something that someone wants help in terms of data collection? Is there something someone wants help with this? And I, you know, I can get my name on it. Um And I can help them with this and that, that way, you know, you can take one box and you can look forward to another one and essentially collaboration is key. You get more stuff done if you have a few people that interested. Um And if you want to read more open audits, which I don't think, you know, if you want to do that. So, thank you. That's the end and I would end the show. Thank you very much, Doctor Jaguey for representation has been very, very educative. Uh We'll be opening the lines for questions. Um Please, if you have any questions that have not been typed into the chat box, please, can you um do that? Now, we have some questions that are already um in there. Should I read them out or would you be able to see them? I can you can read them out or I can have a look as well just to make sure we um okay, I guess first one has been answered. Um There was a question about where can we find this audit? Uh I think you've been able to elaborate very, very much on that, the audit live discussion with trainees and consultant. Um There's also a question of uh for I MGS will audit performed locally, be recognized in the UK. Is he audits performed locally? Like is it like back home in Nigeria or somewhere else or uh in Africa anywhere? Yeah, I mean, he's recognized, like I said, you know, someone did an audit oversee and you want an award in the UK, so you cannot be done or you just have to make sure you is that you're involved in all the right stakeholders. You know, you want to make sure that um you know, a consultant way you work in, in that particular hospital is going to give you a reference or some form of letter that you did this audit and really try and present it somewhere and try and get a certificate for doing that presentation and that's it. That's all you need. You just need to have a documented evidence, you know, like, you know, all things that you do, you need to just have a way of documenting it. I mean, if you're working again, hs then it's very easy for, it's documented because most of the time they, you know, they already have templates, they already have um um audit certificates that you can get from your department or you can present in, you know, different conferences all over the country. You know, that can get, you know, you can get a presentation from, well, you know, sometimes it's very difficult to get that broad, but you need to have that mind before you do an audit, you know, you have to have, like, okay, I need to get a certificate for that. Um, and obviously you need to be able to have their mind so that when you're pursuing the project you're doing it to make sure that whoever you're doing the project with or whichever institution you work, we'll be able to give you some form of, uh, uh, certificate for it because that's what you need for your portfolio. Yeah. Yeah, I think that's very important, especially for those of us who are still like very early in our medical career. Find out your medical students or um or just like early June, your doctors were able to start getting this uh proof of um audit presentation or participation in all this process every enough. Yeah. Prior to something that we didn't do, um especially the fact that you've got a lot of similar projects, we did stuff, you know, like that or you just do it and you move on when you didn't, when your house officer, you know, and you didn't really document these things. And um they play a huge role here because obviously the good thing about NHS is that they tend to organize things from abroad. But, you know, you need to have um an evidence. It's verifiable, you need that is that it has been done. Okay. So there's another question from um for me who says uh the criteria says two audits, um, that have changed practice. Does this mean for cycles, two cycles for each audit or, um, do we just need one, um, audit than then they reacted to check for chain practice? Very, very good question. I, I personally don't think that it's been asking you to do four cycles. Um, or it doesn't necessarily mean that you have to be the person that have actually done the, the four cycles. Um, uh, you know, for example, if someone else did an audit and they did the first cycle and you're just doing the re audit, right? That's one audit. That's a close look audit. And actually you let that audit because you led to the fact that the audit got finished and you use close look. So essentially my just doing what cycle of an audit that have been done before, um you manage to get one closed lipped audit. And again, um it can mean four cycles because you might start an audit and finish an audit. That's one. So that's two cycles. You start another audit and you know, do another audit. That's too. But again, it depends on the contest. Um which is why I always talk about the fact that you need to involve the right stakeholders if you need to get these things done because they can take a bit of time. It can, it requires a bit of an effort to do. But if you involve the right people, it can actually become easy and very streamlined. You can find projects that have been done before that just need someone to close the loop. And that's one what it you know, done or you can obviously start a new project of fresh and pick something that you can easily do the data collection in a few hours. And that's your first cycle done. And then you can find a way to present it and do the re audit, which may take a bit of more time to do. And that's your second cycle done. I hope that and again, changing practice sounds like a big term. It's not changing practice. Like I said, simply means that you're showing that numbers are moving on a graph, you're showing that 20% is not 30% you're showing that 40% and 50% you're showing that, you know, 50 patient's are being seen instead of 30. That's essentially what changing practice means. You know, changing practice doesn't mean that the CEO of the hospital have to come and shake your hands based on the audit that you did change in practice can actually mean something very, very simple. Um They shouldn't be just, you know, just don't think about changing packed on something really, really difficult. Okay. Um Before the last question, I just want to say we'll be putting the feedback link shortly in the child box. So um those of us, we would, we would, we welcome feedback from every person was attended this program. Um, the, the next question says, um, can you do a radiology department that's unrelated to the department you walk in? Yes. Example, if one works in O M G, you know, absolutely. 100%. You can definitely do a radiology. I mean, even on the top of my head you can do a topic on, you know, um, adequacy of, uh, I mean, there's something probably on, um, there's, uh I don't know what I can think of the top of my head in terms of uh auras. If you think, if you think about auras, which means radiology reporting system for, for ovarian cyst ovarian tumors, for example, you can easily do that and you can, all you just have to do is to speak to one of the sonographer Zor, speak to your energy department and say you're, you're, you're working in orbs and gain and you're keen on doing, um, um sort of an audit that is related to, um, um sort of obstetrics or gynecology. You know, lots of artists that you could do um that radiology related. And remember if you do an audit that is not really related and you can present it in a conference, you can still claim points for it as well. Um So, you know, that's still something that can, you know, still, still do as well. But in terms of being in orbs and gain again, there are loads and loads of, you know, audits related to it, watch it. I can do enough sang gain. Uh, I'm 100% sure of it and I'm sure that if you obviously even go to audit life now, just, I can't think of any example or on the top of my head, there will certainly be a lot of, um, um, topics, you know, that you can find. Again. You need to find something that is doable. You need to find something that is a problem that you think is a problem uh in your department need to run it by someone first to make sure that they agree with you that actually this can be done before you go about doing it um as well. And it's always important that if you actually just find a way to speak to someone in the radiology department, I'm sure that they will have, you know, they'll be more than welcome to, um, either find a topic for you or guide you in terms of, you know, how to be able to do and holidays probably related to where you work. Um There's one more question. Uh I would assume that we don't have any more questions. Um If we have, please just make sure you put it in next time to three minutes so we can address them on time. And the next question is um from Ikimi who says, um would an audit done on a respiratory, what counts as a radiology audit if it involves data analysis from parks. So that's the picture. Uh, yeah, if you're looking at chest x rays, yes. You said your job as far as I'm concerned, you know, if you're, if you look at any formal religion investigation, yes, you do what you did. Um, all right. Yeah, it's a radiology at it, you know, ultrasound, guided a stick types of draining the gastro would. Yes. Um, that's still definitely a radiology, uh about it as well because, you know, um they're still involves some form of imaging to be honest. And again, it depends on how you want to spin it. The most important thing is that you're looking at is this improving patient outcomes, is this improving the process? Um And can you demonstrate any change at all from it once you can be able to show that that's it. And can you find a way to present it somewhere and can someone give you a certificate for it? You know, that's definitely the counters radiology or did um ultrasound guided but auto so guided procedures on the ward can actually win an award if you actually design it properly because sometimes can can be a big problem in terms of big hospitals that have big interventional radiology department because they tend to get this ultrasound guided, that stick types of drains. Or if you can demonstrate that people on the world can do it with imaging guidance without having to overload the interventional radiology department, you know, you're already thinking about yourself within, within a world with this, with this poster. Like I said, you just need to have to find a way to, you know, to find a template. Someone somewhere has probably done this before. You just need to find that audit, you know, search the internet properly, search previous conferences, there's probably a poster somewhere on it, you know, they can find um and then you can be able to plan your audit around it and then find Axion plans that do a but you don't want to do things that are too difficult, that too difficult for you to do because that's when you run into trouble, you have to find something that, like I said, you have to know the end from the beginning. And in that week, I'll be able to find a way to be able to, um, you know, present it somewhere and get a certificate for it or something. All right. Um, uh, we don't have any more questions on the presentation. Um, so we have a group for members of the Radiology interest group, Africa. If you're, um, there'll be a link um, posted very shortly in the chat box if you're interested in joining it to be a member. Um, we have, um, we're trying to, we're working um, to have access to multiple trainees that we can, we can work with, especially get guidance from as they are. Um, um, more very much more experienced and I'm engaging, you know, does a number of us have done? But the trainees have more experience with and we have more access. So we um we are working to create some sort of like a collaborative space where we can so get more experiences, mental ourselves, support ourselves towards them engaging in this project. Um I saw someone asked them for um doctor uh makers, linkedin uh project. Uh uh I have a lot happening on linkedin to be honest. Yeah, just my name on Lincoln's. Yeah. So you can be connected with him to on the group page also. And uh that's the uh the whatsapp page we have for the members. And yeah, you can, you can reach out to in Burlington also. Um So we um in the absence of um any other questions we'd like to see. Very big. Thank you to doctor Equi who's been very um supportive towards um the goals of this um interest group and um take for taking the time to prepare slide and teach uh make a presentation and also um answer the questions we have um just be very hopeful and Miss Eiffel and um sort of anyway, you've been being able to demystify the process. We're no longer, I don't see it anymore as the process of um a big thing is just finding something that works a good topic, good supervisors and I'm trying not to bite more than you can chew and trying to do it. Yeah. Do like things that would definitely impact um the clinical practice positively um wherever we are in the world, in the UK and also elsewhere um would um for following this presentation, we'll have a just a short, a short announcements from the academic lead um about our future programs. Um So um Doctor Finley would, would be a help, help penis with that. Hello, everyone. Hello. Okay. Thank you. Thank you very much, Doctor Ego. I really love your presentation. Thank you everyone for joining our very first event. I hope we so see more of you uh up coming up next. We hope to have like a research would come if I can put it that way. We're, we're trying to put up a structure to help with our portfolio. One of the things that we need to get is publication. So uh I would like you guys to register to the members or we're trying to put up a team that would help us to get a publication or if there's a first daughter or you collaborate with a friend just to at least get the point for publications as well. So be on the lookout for that. Thank you. Yeah. Um We'll be joining this um event to close um shortly. So uh we, we will send um a link, there's been a link in the chat box for feedback. Um If you have any questions or you have any inquiries. Um The our concept address down the descriptor for this event, but our email is um radiology Interest group Africa at gmail dot com. You can always send us a message and we'll respond to, to eat as soon as we're able. Um We also, um I've also pasted um a link um to uh the to register as a member if you're interested in uh you know, other programs we like uh the educational lead explained, we're trying to organize a program where um uh sort of like a support group and we get people who have engaged in multiple research, um who can guide us to give teachers through some research methods. For those who want to like publish papers. We want to engage Maria in the process of research. Um We'll be able to like have like a support group over the next period of four months and um we're looking to start this by next month. So um it would be helpful if you join on time and indicate your interest. Um So we can plan appropriately um towards it. Um I would like to say a big thank you for everyone who's being a part of it and that the team was helped with organizing this year uh doing a lot in the background um to ensure that this program is um this event almost a success. So I just appreciate everyone will um was able to turn out and the attendees. Thank you. Very much and I have a nice evening.