A preliminary audit of orders for computed tomography was performed to evaluate the typical performance of interns ordering radiologic examinations. According to the audit, the interns showed only minimal improvement after 8 months of work experience. The online radiology ordering module (ROM) program included baseline assessment of student performance (part I), online learning with the ROM (part II), and follow-up assessment of performance with simulated ordering with the ROM (part III). A curriculum blueprint determined the content of the ROM program, with an emphasis on practical issues, including provision of logistic information, clinical details, and safety-related information. Appropriate standards were developed by a committee of experts, and detailed scoring systems were devised for assessment. The ROM program was successful in addressing practical issues in a simulated setting. In the part I assessment, the mean score for noting contraindications for contrast media was 24%; this score increased to 59% in the part III assessment (P = .004). Similarly, notification of methicillin-resistant Staphylococcus aureus status and pregnancy status and provision of referring physician contact information improved significantly. The quality of the clinical notes was stable, with good initial scores. Part III testing showed overall improvement, with the mean score increasing from 61% to 76% (P < .0001). In general, medical students lack the core knowledge that is needed for good-quality ordering of radiology services, and the experience typically afforded to interns does not address this lack of knowledge. The ROM program was a successful intervention that resulted in statistically significant improvements in the quality of radiologic examination orders, particularly with regard to logistic and radiation safety issues.

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Background The Axial Spondyloarthritis Specialist Interest Group North-west (ASSIGNw) is a regional network of physiotherapists with special interest in axial spondyloarthritis. The group meets to share best practice and provide a forum for professional support. The National Axial Spondyloarthritis Society (NASS) ‘Aspiring to Excellence’ campaign highlights the need for co-production and sharing of expertise as being imperative to the improvement of care for all this group of patients. A consensus sharing exercise was performed within the group to look at addressing this. Following discussions, there was an aim to create a ‘top tips’ for practice guidance for sharing with colleagues both in the group, and nationally. Methods During the March 2019 meeting, each member was invited to share their top tips for practice. After this sharing exercise, two members of the group reviewed and themed the suggestions. This thematic analysis was then shared by email to all group members to allow for further contributions. An additional opportunity within our next group meeting was used to ratify the themes and provide group endorsement. Results Suggestions for top tips for practice included ‘Do’s and Don’ts’ and fell into 2 main categories: patient care and service delivery. ‘Do’s for patients’ related to ‘Communicate and educate’ focusing on therapists communication, the importance of explaining diagnosis, giving reassurances and signposting patients to appropriate educational materials. The ‘Assessment’ theme included suggestions to acknowledge importance of therapeutic relationship building, using detailed history compilation to learn the patients’ journey, co-morbidities, sleep hygiene and fatigue, and the impacts these have on quality of life. In contrast, ‘Don’t’s for patients’ warned of ‘Being aware’ emphasising the difficulty of arriving at a diagnosis and the pitfalls with con-concomitant chronic widespread pain or Fibromyalgia. ‘Do’s for service’ describes the ‘Communicate with all’ theme highlighting the need to be all inclusive with every member of the service, liaising both with internal and external stakeholders but more importantly focusing upon the needs of patient and the services responsiveness to changes in these. ‘Don’t's for service’ were themed as ‘Silent Gremlins’ warning colleagues to be aware of invisible undercurrents or issues within practice or services and being unafraid to identify weaknesses within the service. Examples included poor booking systems or analysing the ‘one time it went wrong’ when it mainly goes ‘right’ experiences. Conclusion We have described a short consensus sharing exercise in which experienced clinicians on a regional basis have been able to contribute their views on what works well and what doesn’t work well for both patients and practice. This work has produced a brief guide or ‘sharing tool’ which can be built upon to help experienced and more importantly less experienced colleagues to develop their practice. Disclosures W.J. Gregory: Honoraria; W.G. has received speaker fees from Novartis and received Conference attendance fees from Pfizer. J.S. Brazendale: None. C. Longton: Honoraria; C.L. has received sponsorship support from Novartis, Pfizer and UCB. N. Marshall: None. J. Martindale: Honoraria; JM has received honoraria from Abbvie Ltd, Novartis, Pfizer and UCB. Grants/research support; JM has received a research grant from Pfizer.