Po-Hao Chen MD, MBA, Presenter: Nothing to Disclose

Yin Jie Chen MD, Abstract Co-Author: Nothing to Disclose

Alexander T. Ruutiainen MD, Abstract Co-Author: Nothing to Disclose

Sung Han Kim MD, Abstract Co-Author: Nothing to Disclose

Tessa S. Cook MD, PhD, Abstract Co-Author: Nothing to Disclose

Radiology residents provide independent preliminary interpretations for studies performed after hours in many academic programs. While we are told that "the more you see, the better prepared you are," a paucity of literature exists on the efficacy of this approach. In this study, we determine whether residents who interpreted more musculoskeletal (MSK) radiographs in their first year also produced more concordant reports when taking call the next year.

MSK radiographs reported by first year residents from 2009-2013 during a dedicated MSK rotation were retrospectively reviewed. The cohort’s performance while taking call was then studied during their second year of residency. Each overnight on-call MSK radiograph and associated preliminary report study was independently reviewed by one of seven MSK subspecialists. Preliminary reports were evaluated, and reports with discrepancies graded as "Major Change" or "Minor Change" at the discretion of the faculty radiologist. Residents were divided into quartiles based on their first-year study volumes. The Major Change, Minor Change, and total discrepancy rates between residents in the highest and lowest quartiles were compared using Student’s t-test.

As first-year residents, the cohort (n=36) interpreted a total of 24,932 radiographs during their MSK subspecialty rotations. While taking second-year call, they interpreted a total of 16,269 MSK radiographs, of which >70% were peripheral extremity (wrist, hand, ankle, foot) and large joint (hip, knee, shoulder, elbow) cases. The highest quartile first-year residents interpreted a mean of 1182 cases each, versus 599 studies for the lowest quartile (p<0.000001). The on-call discrepancy rate for peripheral extremities was 12.2% in the highest quartile and 18.6% in the lowest quartile (p = 0.011). The discrepancy rate for large joints was 10.6% in the highest quartile vs. 17.5% in the lowest quartile (p = 0.002). No statistically significant difference were seen in the other skeletal categories.

First year radiology residents who reviewed the most MSK radiographs on rotation have up to one third lower total discrepancy rates than their peers when taking independent call the following year.

Radiology residents may significantly improve their interpretations of on-call MSK radiographs by maximizing volume of interpreted radiographs during their first-year MSK subspecialty rotations.

Chen, P, Chen, Y, Ruutiainen, A, Kim, S, Cook, T, The More You See - Effect of First Year Residents’ Interpretation Volume on Independent Call as Second Year Residents.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006002.html