Accurate interpretation of chest radiographs (CXR) is essential since house officers are required to make clinical decisions based on their readings. We sought to evaluate CXR interpretation competency at different levels of training and to determine if specific factors are associated with successful interpretation.
Participants (n=145) from a single teaching hospital were third year medical students (MS) (n=25), internal medicine (IM) interns (n=44), residents (n=60) from the departments of IM and radiology, and fellows (n=16) from the divisions of cardiology and pulmonary/critical care. Participants reported their confidence in interpreting CXR on a scale of 0-10. They also reported their interest in a pulmonary career and perceived adequacy of CXR training. Ten conventional CXR were selected from the teaching file of the IM Department. The CXR included one normal radiograph and three examples of emergencies (pneumothorax, misplaced central line and pneumoperitoneum). Participants were asked to record the most important diagnosis. Two investigators independently scored each CXR on a scale of 0-2.
The median interpretative score was 11 out of 20. An increased level of training was associated with an increased score (MS 8, intern 10, resident 15, fellow 15, p<0.001). Self-reported confidence (0-10) in interpreting CXR also increased (MS 4.0, intern 4.5, resident 6.0, fellow 6.0 p<0.001). Certainty was significantly correlated with interpretative score (r=0.606, p<0.001). IM interns and residents interested in a pulmonary career scored 14 while those not interested scored 11 (p=0.037). Radiology residents were more confident (7.0 vs. 5.0, p=0.021) and scored higher (18 vs. 11, p<0.001) than IM residents. Pneumothorax, misplaced central line and pneumoperitoneum were diagnosed correctly 9%, 26% and 46% of the time, respectively. Only 20 of 131 (15%) participants felt that their CXR training was sufficient.
We identified several factors associated with successful CXR interpretation - level of training, field of training and confidence. Although interpretation improved with training, important diagnoses were often missed.
More training in CXR interpretation is required with an emphasis on emergencies.
Lewis Eisen, None.