Robert Joshua Dym MD, Presenter: Nothing to Disclose

Judah Burns MD, Abstract Co-Author: Nothing to Disclose

Benjamin Taragin MD, Abstract Co-Author: Nothing to Disclose

Appropriateness criteria were developed by the ACR as guidelines for the proper utilization of diagnostic imaging. The purpose of this study was to determine the proficiency of emergency medicine residents in selecting the most appropriate radiologic examination for specific clinical scenarios, and to ascertain whether their training improves competency in this area over the course of their residency.

The study was certified by the Institutional Review Board to be exempt from review. An online multiple-choice questionnaire was created using SurveyMonkey.com. It included ten clinical scenarios excerpted from the ACR Appropriateness Criteria® guidelines and instructed residents to select the most appropriate initial imaging study. Correct answers were based on the ACR guidelines. A link and invitation to the survey was emailed to the residency program directors and coordinators of all ACGME-accredited emergency medicine residency training programs with the request that they forward the email to their current residents. Responses were graded, with results stratified by year of emergency medicine training. An analysis of variance (ANOVA) was performed.

A total of 583 residents from at least 77 different emergency medicine residency training programs completed the online survey. This included 202 residents in their first year of emergency medicine training, 190 second-year residents, 159 third-year residents, and 32 fourth-year residents. Overall, the average number of questions answered correctly was 7.1/10 (SD 1.2). First-year residents averaged 6.9 (SD 1.3) correct answers, second-year residents averaged 7.1 (SD 1.2), third-year residents averaged 7.1 (SD 1.1), and fourth-year residents averaged 7.4 (SD 1.1). ANOVA demonstrated no significant difference between the scores of the four classes (p=0.09).

Emergency medicine residents do not demonstrate significant improvement over the course of their residency in their ability to choose appropriate imaging studies. This suggests that there may be a role for more rigorous focused instruction to better familiarize them with appropriateness guidelines for diagnostic imaging selection.

The lack of improvement in radiologic ordering practices by emergency medicine residents over the course of their training supports increased emphasis on education in the use of imaging guidelines.

Dym, R, Burns, J, Taragin, B, Appropriateness of Imaging Studies Ordered by Emergency Medicine Residents: Results of an Online Survey.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009286.html