Competency in chest radiography: A comparison of medical students, residents, and fellows

Lewis Eisen, Jeffrey S. Berger, Abhijith Hegde, Roslyn F. Schneider

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

BACKGROUND: Accurate interpretation of chest radiographs (CXR) is essential as clinical decisions depend on readings. OBJECTIVE: We sought to evaluate CXR interpretation ability at different levels of training and to determine factors associated with successful interpretation. DESIGN: Ten CXR were selected from the teaching file of the internal medicine (IM) department. Participants were asked to record the most important diagnosis, their certainty in that diagnosis, interest in a pulmonary career and adequacy of CXR training. Two investigators independently scored each CXR on a scale of 0 to 2. PARTICIPANTS: Participants (n=145) from a single teaching hospital were third year medical students (MS) (n=25), IM interns (n=44), IM residents (n=45), fellows from the divisions of cardiology and pulmonary/critical care (n=16), and radiology residents (n=15). RESULTS: The median overall score was 11 of 20. An increased level of training was associated with overall score (MS 8, intern 10, IM resident 13, fellow 15, radiology resident 18, P<.001). Overall certainty was significantly correlated with overall score (r=.613, P<.001). Internal medicine interns and residents interested in a pulmonary career scored 14 of 20 while those not interested scored 11 (P=.027). Pneumothorax, misplaced central line, and pneumoperitoneum were diagnosed correctly 9%, 26%, and 46% of the time, respectively. Only 20 of 131 (15%) participants felt their CXR training sufficient. CONCLUSION: We identified factors associated with successful CXR interpretation, including level of training, field of training, interest in a pulmonary career and overall certainty. Although interpretation improved with training, important diagnoses were missed.

Original languageEnglish (US)
Pages (from-to)460-465
Number of pages6
JournalJournal of General Internal Medicine
Volume21
Issue number5
DOIs
StatePublished - 2006
Externally publishedYes

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Internal Medicine
Medical Students
Radiography
Thorax
Lung
Radiology
Pneumoperitoneum
Pneumothorax
Critical Care
Cardiology
Teaching Hospitals
Reading
Teaching
Research Personnel

Keywords

  • Clinical competence
  • Education
  • Educational measurement
  • Medical
  • Radiography
  • Thoracic

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Competency in chest radiography : A comparison of medical students, residents, and fellows. / Eisen, Lewis; Berger, Jeffrey S.; Hegde, Abhijith; Schneider, Roslyn F.

In: Journal of General Internal Medicine, Vol. 21, No. 5, 2006, p. 460-465.

Research output: Contribution to journalArticle

Eisen, Lewis ; Berger, Jeffrey S. ; Hegde, Abhijith ; Schneider, Roslyn F. / Competency in chest radiography : A comparison of medical students, residents, and fellows. In: Journal of General Internal Medicine. 2006 ; Vol. 21, No. 5. pp. 460-465.
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abstract = "BACKGROUND: Accurate interpretation of chest radiographs (CXR) is essential as clinical decisions depend on readings. OBJECTIVE: We sought to evaluate CXR interpretation ability at different levels of training and to determine factors associated with successful interpretation. DESIGN: Ten CXR were selected from the teaching file of the internal medicine (IM) department. Participants were asked to record the most important diagnosis, their certainty in that diagnosis, interest in a pulmonary career and adequacy of CXR training. Two investigators independently scored each CXR on a scale of 0 to 2. PARTICIPANTS: Participants (n=145) from a single teaching hospital were third year medical students (MS) (n=25), IM interns (n=44), IM residents (n=45), fellows from the divisions of cardiology and pulmonary/critical care (n=16), and radiology residents (n=15). RESULTS: The median overall score was 11 of 20. An increased level of training was associated with overall score (MS 8, intern 10, IM resident 13, fellow 15, radiology resident 18, P<.001). Overall certainty was significantly correlated with overall score (r=.613, P<.001). Internal medicine interns and residents interested in a pulmonary career scored 14 of 20 while those not interested scored 11 (P=.027). Pneumothorax, misplaced central line, and pneumoperitoneum were diagnosed correctly 9{\%}, 26{\%}, and 46{\%} of the time, respectively. Only 20 of 131 (15{\%}) participants felt their CXR training sufficient. CONCLUSION: We identified factors associated with successful CXR interpretation, including level of training, field of training, interest in a pulmonary career and overall certainty. Although interpretation improved with training, important diagnoses were missed.",
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