An evaluation of a short chest radiograph learning intervention to evaluate internal medicine residents' ability to identify basic pathologic abnormalities and normal anatomy

Patrick J Troy, Edward L Salerno, Peruvamba Venkatesh
Connecticut Medicine 2006, 70 (7): 421-5; quiz 426-9

BACKGROUND: The correct interpretation of chest radiographs is an essential skill for internal medicine residents. Little formal training in radiology occurs in the graduate medical curriculum for internal medicine residents.

OBJECTIVE: To assess the performance of internal medicine residents in the interpretation of chest radiographs through a 1.5-hour didactic and practical session.

DESIGN: Baseline performance was assessed in the first week of a four-week rotation. An intervention was performed in the second week. Post-intervention assessment was performed in the fourth week.

SETTING: A university-based internal medicine residency.

PARTICIPANTS: Internal medicine residents at all levels of training.

INTERVENTION: A 1.5-hour review session addressing: technique, anatomy, pathophysiology and disease pattern recognition through small group didactics.

MEASUREMENTS: 38 multiple choice question assessment tool designed to assess comprehension of fundamental knowledge of chest radiograph interpretation.

RESULTS: At baseline, residents were able to answer 64% of questions correctly. After the intervention, 77% of questions were answered correctly, an improvement of 13 percentage points (95% CI = 8.4 percentage points to 16.3 percentage points; P = 0.0001). No significant differences in performance were demonstrated between PGY1 and upper level residents (PGY2 and PGY3) at baseline (P = 0.11), however senior residents (PGY2 and 3) were found to perform significantly better than interns after the intervention (P = 0.002).

CONCLUSIONS: Internal medicine residents perform poorly at baseline in the assessment of chest films. Interventions designed to address core competencies in chest radiograph interpretation can be efficacious in improving residents' interpretive skills. The incorporation of formal education in chest radiograph diagnostic skills into graduate medical education may be of significant benefit to internal medicine residency training.

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