No author has involvement with organizations with financial interest in the study matter.
Competency in Chest Radiography
A Comparison of Medical Students, Residents, and Fellows
Article first published online: 25 APR 2006
Journal of General Internal Medicine
Volume 21, Issue 5, pages 460–465, May 2006
How to Cite
Eisen, L. A., Berger, J. S., Hegde, A. and Schneider, R. F. (2006), Competency in Chest Radiography. Journal of General Internal Medicine, 21: 460–465. doi: 10.1111/j.1525-1497.2006.00427.x
- Issue published online: 25 APR 2006
- Article first published online: 25 APR 2006
- clinical competence;
- educational measurement
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.