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Objective:
Traditional peer review systems require radiologists to score the performance of their colleagues. Frequent poor scores may negatively impact radiologist wellbeing and stimulate a toxic work culture. The objective of this project was to cultivate a more constructive, wellness-promoting peer learning system through the Gold Star Initiative, a program to applaud and acknowledge outstanding work as a method of peer review.

Materials and Methods:
A "Gold Star" option was introduced into our peer learning system where radiologists could submit cases they felt were deserving of recognition. Case submissions were facilitated through an existing intranet system with accompanying email notifications to both the submitter and the recipient of the feedback. After 5 months, data regarding submissions before and after the implementation of the Gold Star category were collected. We analyzed submission quantity, case submission types (positive vs. negative feedback), and case submitters (attendings, technical staff, trainees). The data were compared to the results in the same 5-month timeframe from the previous year to eliminate seasonal differences. Chi-square tests were used to determine if the changes were statistically significant.

Results:
Positive feedback to clinicians increased significantly during the first 5 months of the Gold Star Initiative, with 66 positive submissions, increased from 32 during the same 5 months the previous year (p = 0.002). All submissions were performed by clinicians, most commonly attendings. Most of the positive feedback was addressed to attending radiologists and physician trainees. Technologists comprised 8% of positive feedback recipients, compared to 6% in the previous year (p = 0.57, not statistically significant). Positive feedback volume trended downward in the months after inception.

Conclusion:
After the introduction of the Gold Star category, positive feedback submissions to our peer learning database more than doubled, highlighting the potential of positive reinforcement in peer review. A change in paradigm from focusing solely on mistakes to also acknowledging commendable performances holds promise in improving objective and subjective measures in radiologic peer review. Future avenues of research include analyzing data over larger time frames, promoting buy-in among technologists, and exploring effects on learning, job satisfaction, and burnout among radiologists and staff.