Trainee guide to the MDT meeting
Tips to maximising learning and advice on preparing and presenting at MDT meetings during training
Learning to participate in clinico-multidisciplinary team (MDT) meetings is part of the core curriculum for radiology trainees. The Royal College of Radiologists (RCR) eportfolio Workplace Based Assessments include an MDT Assessment Tool, which is mandatory for trainees in years 4 and 5 and assesses your ability to prepare for and present at MDT meetings.
This guide is to help trainees develop the skills required to present radiological findings at MDT meetings. Many of the suggestions are most pertinent to cancer MDT meetings, however the general format can be applied to non-cancer MDT meetings and clinicoradiological meetings as well.
Eportfolio MDT meeting assessment tool
MDT eportfolio assessments are mandatory for ST4 and 5 trainees and also a useful tool at any stage to gather formal feedback on performance, identify areas for improvement and evidence engagement with the MDT component of the core curriculum.
Once you feel confident leading an MDT meeting without a consultant present it is imperative that you are signed off for the particular examinations reviewed in the meeting and ideally signed off as independent for the specific MDT meeting using the eportfolio assessment tool.
Guidance for completing the MDT assessment is available on the eportfolio system or the RCR website.
Formal teaching sessions for MDT preparation and presentation
You should be given formal teaching sessions on MDT preparation and presentation as this is a core part of the curriculum. This is important to ensure a good standard of training. If this is not available within your training programme, we recommend you ask your programme director if a session can be arranged.
As a basis for teaching, the RCR recommends that you should:
- Have adequate time to review cases and previous imaging prior to the meeting
- Demonstrate appropriate written and verbal communication skills during meetings
- Exhibit good presentation skills
- Work with MDT colleagues
- Appropriately manage time
- Participate in decision-making with regard to patient management and leadership skills
- Recognize when to involve other people
- Current staging guidelines.
- Criteria used to assess for treatment response.
- Local management pathways.
Here is some advice for ST1 and 2 trainees on how to make the most of learning opportunities when attending and observing MDT meetings.
- The best opportunity for optimizing learning is to attend the radiology consultant's MDT preparation session:
- Ask the consultant in advance if they are happy for you to do this. This can be a busy session. It may be that they only have time to go through a few cases with you.
- Preparation includes more than reviewing the most recent imaging. Take note of everything else involved. Things to review may include clinical history, previous imaging, blood results and biopsy results.
- When reviewing imaging take note of the salient points that the consultant looks for. Some findings change the stage of disease and have important implications for treatment whilst other findings are less relevant. Certain findings are important for the surgeons to know if they will affect the surgical approach.
- This is a good time to note management issues such as how to deal with scans needed for the meeting which have not been reported or issues with imported imaging.
- If you are not able to sit with the consultant, ask the MDT meeting co-ordinator for a copy of the meeting list so that you can familiarize yourself with the patients and review the imaging by yourself. Make a note of any questions you have to ask at a later time.
- Maximizing learning during the meeting:
- Make sure you have a copy of the patient list.
- Ask to sit next to the consultant radiologist if possible so that you can see the high resolution screens and ask questions discretely if appropriate.
- Observe the leader of the meeting and reflect on good aspects of leadership that you could use in the future.
- Note the radiology consultant's presenting style and what information is given.
- Observe the use of PACS and how it can be maximized to aid the meeting. Ensure you are fully aware of useful PACS tools such as bookmarking images and adding labels.
- Note the clinical team's questions and the imaging findings which are important to them.
- Note any questions you have to ask the consultant afterwards if it is not appropriate to ask during the meeting.
- Keep a note of interesting patients and patients who you may want to follow up.
As an ST3 or 4 trainee you should begin running an MDT meeting. Here is some guidance to help you make this step-up!
- The supervising consultant should give you details of the MDT co-ordinator so you can be added to the mailing list to receive pre-MDT meeting documentation and outcome details.
- When starting to take MDT meetings (ST3) ask to be given a small selection of cases rather than the whole meeting. For example, 5 new cases and 5 follow-up cases.
- Aim to present these cases to the consultant radiologist prior to the meeting initially before subsequently progressing to presenting at the meeting. Ask to present your cases first, at the start of the meeting, when the meeting is likely to be less time pressured.
- ST4 trainees should aim to prepare the whole meeting.
- A consultant radiologist who is a core MDT member should be present to offer support until the trainee is confident to run an MDT with indirect support (which is expected during ST4-5).
- Ensure that your timetable includes time for adequate preparation and a debrief with a consultant to facilitate feedback on performance.
- Aim to run MDT meetings at post Fellowship of the Royal College of Radiologists (FRCR) 2B level.
- Before leading an MDT meeting independently, it is essential that you have been signed off for the particular examinations reviewed in the meeting and ideally signed off as independent for the specific MDT meeting using the eportfolio assessment tool.
- Check that you have timetabled time for MDT meeting preparation. Ensure that the timing of the preparation time gives time to discuss the cases with your consultant. The time required to prepare each case will vary depending on your experience and the nature and complexity of the case.
- Focus on previous imaging, creating key images and make written notes to review during the meeting.
- Note the TNM stage or treatment response for cancer MDT meetings.
- Remember to note important incidental findings. The “palliative sweep” is a useful review tool in cancer imaging used to identify incidental findings which can be treated to improve quality of life. Examples include:
- Cord compression.
- Tube blockage: bowel, bile duct, ureters, trachea etc.
- Complications: therapy induced lung damage and venous or pulmonary thromboembolism.
- Arrive 10 min early. Familiarize yourself with the MDT room and projection/image display hardware.
- Introduce yourself to the MDT members. Sign the register as a record of your attendance.
- Ask that cases are reviewed in the order of the agenda when you start out to reduce the stress of finding your notes and images.
- Do not review cases ad hoc in the meeting when you have not had preparation time.
- Present images in a timely fashion:
- Demonstrate communication skills and learn to concisely summarize findings. Use your preparation notes.
- Create key images on PACs. Arrows may be helpful.
- Coronal reformats aid understanding for non-radiology colleagues.
- Show pertinent findings that may influence management.
- Actively contribute to decision-making regarding patient management and address the radiological issues.
- Learn to lead a team and resolve conflict within a team. The radiologist as a generalist is often in a good position to direct the meeting. Be aware of time keeping and encourage the team to draw conclusions.
- An addendum or other form of formal documentation should be made to record the discussion and outcome of the meeting. This facilitates easy access to the management plan for future care, and can be particularly useful when reporting follow-up scans.
- Ask what your local policy is. If there isn’t one, consider introducing one as a quality improvement project.
- Know your limits and when to ask for help. Ensure that senior help is available if necessary during preparation and during the meeting. Indirect supervision may be appropriate if you're a senior trainee and signed off to an appropriate level.
- If you are asked to run a meeting on your own and you do not feel comfortable with this, ask for a consultant help. If this is not available, more senior trainees may be in a position to help. If help is not available raise the issue with your clinical or educational supervisor. Patient safety is paramount and is at risk if you feel out of your depth with no help to run a meeting.
- At any level of training if you are not sure and there is no direct help available, explain this to the meeting; it may be appropriate to seek advice after the meeting and relay the outcome back to the MDT members.
So, that's it!
Thanks for reading this guide to the MDT meeting. We hope you found it useful.
This guide was taken from the following paper published by the BJR in 2017: Hudson SR, Little D, Mathew A, Rosof-Williams D, Pathiraja F, Varghese K, J Stephenson. Multidisciplinary team and clinical meeting data: JRF national survey of trainees 2015. Br J Radiol 2017; 90: 20170156 and reproduced here with permission from Dr James Stephenson.
As ever, if you have any comments or suggestions for improvements, please contact us.