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Competency in chest radiography

A comparison of medical students, residents, and fellows

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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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Authors and Affiliations

  1. Division of Pulmonary and Critical Care, Beth Israel Medical Center, New York, NY, USA

    Lewis A. Eisen MD

  2. Department of Internal Medicine, Beth Israel Medical Center, New York, NY, USA

    Jeffrey S. Berger MD, Abhijith Hegde MD & Roslyn F. Schneider MD

Authors
  1. Lewis A. Eisen MD
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  2. Jeffrey S. Berger MD
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  3. Abhijith Hegde MD
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  4. Roslyn F. Schneider MD
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Correspondence to Lewis A. Eisen MD.

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No author has involvement with organizations with financial interest in the study matter.

The principal investigator had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Eisen, L.A., Berger, J.S., Hegde, A. et al. Competency in chest radiography. J GEN INTERN MED 21, 460–465 (2006). https://doi.org/10.1111/j.1525-1497.2006.00427.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00427.x

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