PS1-02: ASSESSMENT OF EDUCATIONAL NEEDS FOR RECTAL CANCER MRI AMONG SURGICAL TRAINEES ENTERING COMPLEX GENERAL SURGICAL ONCOLOGY FELLOWSHIP
Sara Nofal, MD, MEd, Y. Nancy You, MD, George J Chang, MD, MSc, Elizabeth G Grubbs, MD, Brian Bednarski, MD; University of Texas MD Anderson Cancer Center

Introduction: Magnetic resonance imaging (MRI) is essential for the clinical staging and operative planning in the multidisciplinary treatment of rectal cancer.  Therefore, surgical trainees should achieve basic competency in the utilization and interpretation of pelvic MRI for rectal cancer.  However, the baseline knowledge and experience with MRI of residents entering Complex General Surgical Oncology (CGSO) fellowships is unknown.  To understand the need for formal educational curricula, a needs assessment survey was conducted to examine the level of competency with pelvic MRI among incoming CGSO trainees.  

Methods: Following IRB approval, a needs assessment survey was administered to chief residents starting U.S. CGSO fellowships in August 2018. The survey evaluated experience with pelvic MRI for rectal cancer during their residency. Additionally, residents’ confidence level in determination of T- and N-stage, assessment of the circumferential resection margin (CRM), and identification of extramural venous invasion (EMVI) was examined. Lastly, the survey assessed the residents’ confidence level in identifying pelvic structures (central, lateral, posterior pelvic compartments) on MRI using a 5-point Likert scale where 0 indicates not confident and 4 indicates very confident.  Scores were reported as below average (0 or 1), average (2), or above average (3 or 4).

Results: Twenty-four of fifty-five residents completed the survey (response rate = 44%). While most respondents (83%) reported that pelvic MRI was utilized frequently for rectal cancer staging in their residency, 67% of residents reported rarely interpreting images themselves for staging or operative planning. Additionally, most residents reported below average confidence in determining T-stage (67%) or N-stage (54%), assessing the CRM (71%), and identifying EMVI (71%). Most residents also reported below average confidence in anatomy, particularly in the lateral and posterior pelvis (71% and 67%, respectively).

Conclusions: Despite the important role of pelvic MRI in the multidisciplinary management of rectal cancer patients, residents entering CGSO fellowships report a lack of confidence in critical elements including staging and anatomy.  The development of an introductory educational curricula in Pelvic MRI targeted to these identified deficits could enhance their clinical experience and begin to prepare them to be active participants in the multidisciplinary management of patients with rectal cancer.