Chest X-ray evaluation training: impact of normal and abnormal image ratio and instructional sequence

Analysing false-positive errors when Australian radiographers use preliminary image evaluation

INTRODUCTION

Diagnostic errors in the emergency departments can have major implications on patient outcomes. Preliminary Image Evaluation (PIE) is a brief comment written by a radiographer describing an acute or traumatic pathology on a radiograph and can be used to complement referrer's image interpretation in the absence of the radiologist report. Currently, no studies exist that focus their analysis on false-positive (FP) errors in PIE. The purpose of this study was to investigate the regions of the body that cause the most FP errors and recognise other areas in image interpretation that may need additional attention.

METHODS

A longitudinal retrospective clinical audit was conducted to determine the accuracy of radiographer PIE's over 5 years from January 2016 to December 2020. PIE's were compared to the radiologist report to assess for diagnostic accuracy. FP and unsure errors were further categorised by anatomical region and age.

RESULTS

Over this period, a sample size of 11,090 PIE audits were included in the study demonstrating an overall PIE accuracy of 87.7%. Foot, ankle and chest regions caused the most FP errors, while ankle, shoulder and elbow caused the most unsure cases. 76% of the unsure cases were negative for any pathology when compared to the radiologist report. The paediatric population accounted for 21.3% of FP cases and 33.6% of unsure cases.

CONCLUSION

Findings in this study should be used to tailor education specific to radiographer image interpretation. Improving radiography image interpretation skills can assist in improving referrer diagnostic accuracy, thus improving patient outcomes.

The Competency of Emergency Medicine Residents in Interpreting Hand X-rays Across the Three Major Regions of Saudi Arabia

Background Interpreting hand X-rays is crucial for emergency medicine residents to accurately diagnose traumatic injuries and conditions affecting the hand. This study aimed to assess the competency of emergency medicine residents in interpreting hand X-rays across three major regions in Saudi Arabia. Methodology We conducted a cross-sectional study involving 100 emergency medicine residents from the Central, Eastern, and Western regions of Saudi Arabia. Participants were presented with 10 clinical case scenarios each accompanied by hand X-rays and were asked to provide their interpretations. Assessment scores were calculated based on the proportion of correct answers for each case. Results Half of the participants (50 residents) fell within the age range of 25 to 27 years, with 61 male and 39 female participants, respectively. Residents in the third year of training (R3) exhibited the highest mean score of 74.83% ± 20.46%. Participants using desktops to view the images achieved the highest mean score of 75% ± 10.49% compared to those using smartphones or tablets. Significant associations were found between age (F = 4.072, p = 0.020), training level (F = 3.161, p = 0.028), and choice of viewing device (F = 7.811, p = 0.001) and assessment scores. Conclusions Our study highlighted that emergency medicine residents in Saudi Arabia demonstrate competent proficiency in interpreting hand X-rays, with higher competency observed among senior residents (R3 and R4), those aged 28 to 30 years, and those using desktops for image viewing.

What works in radiology education for medical students: a systematic review and meta-analysis

BACKGROUND

Medical imaging related knowledge and skills are widely used in clinical practice. However, radiology teaching methods and resultant knowledge among medical students and junior doctors is variable. A systematic review and meta-analysis was performed to compare the impact of different components of radiology teaching methods (active versus passive teaching, eLearning versus traditional face-to-face teaching) on radiology knowledge / skills of medical students.

METHODS

PubMed and Scopus databases were searched for articles published in English over a 15-year period ending in June 2021 quantitatively comparing the effectiveness of undergraduate medical radiology education programs regarding acquisition of knowledge and/or skills. Study quality was appraised by the Medical Education Research Study Quality Instrument (MERSQI) scoring and analyses performed to assess for risk of bias. A random effects meta-analysis was performed to pool weighted effect sizes across studies and I2 statistics quantified heterogeneity. A meta-regression analysis was performed to assess for sources of heterogeneity.

RESULTS

From 3,052 articles, 40 articles involving 6,242 medical students met inclusion criteria. Median MERSQI score of the included articles was 13 out of 18 possible with moderate degree of heterogeneity (I2 = 93.42%). Thematic analysis suggests trends toward synergisms between radiology and anatomy teaching, active learning producing superior knowledge gains compared with passive learning and eLearning producing equivalent learning gains to face-to-face teaching. No significant differences were detected in the effectiveness of methods of radiology education. However, when considered with the thematic analysis, eLearning is at least equivalent to traditional face-to-face teaching and could be synergistic.

CONCLUSIONS

Studies of educational interventions are inherently heterogeneous and contextual, typically tailored to specific groups of students. Thus, we could not draw definitive conclusion about effectiveness of the various radiology education interventions based on the currently available data. Better standardisation in the design and implementation of radiology educational interventions and design of radiology education research are needed to understand aspects of educational design and delivery that are optimal for learning.

TRIAL REGISTRATION

Prospero registration number CRD42022298607.

The Effects of Various Teaching Methods on Chest X-ray Interpretation Skills Among Medical Students and Interns: A Systematic Review

Chest X-ray (CXR) is a common tool used in medical practice. Medical students and interns should acquire knowledge of CXR interpretation, as it is an essential diagnostic tool for a large spectrum of diseases. This systematic review aimed to compare the effect of different intervention techniques on the competency of medical students and interns to demonstrate the level of confidence and competence in interpreting common presentations of CXRs. The population, intervention, comparison, and outcomes (PICO) framework was used to formulate the review question. All related articles in five databases (PubMed, Web of Science, Scopus, Medline, and Embase) were retrieved and the search was completed in March 2023 with no limiters on date and time. The number of relevant studies was 469. A multi-level approach through the Rayyan platform was used for the screening and exclusion processes. Eleven articles were included in the systematic review consisting of eight randomized controlled trials, one quasi-experimental study, one cross-sectional study, and one interventional cohort. Results showed significant effects of teaching methods utilizing deductive or inductive approach, clinical history, patient care comfort survey, and SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled). Contrarily, no significant effect was shown by flipped classroom models and mixed and blocked practice, peer-assisted learning vs. expert-assisted learning, and Chester, an artificial intelligence tool. This review identified beneficial approaches that may enhance the learning outcomes of interpreting CXRs for medical students and interns, highlighting the remarkable impact of SAFMEDS on medical students' ability to identify CXR findings as well as the availability and practicality of online and e-learning resources for students.

Problem-solving in virtual environment simulations prior to direct instruction for differential diagnosis in medical education: An experimental study

Background: Despite acquiring vast content knowledge about the functioning of the human body through university teaching, medical students struggle to transfer that knowledge to one of the core disciplinary practices - differential diagnosis. The authors aimed to overcome this problem by implementing computer-based virtual environment simulations in medical education courses. Methods: In an experimental study, the authors compared problem-solving in medical computer-based virtual environment simulations prior to instruction with an instruction-first approach. They compared the effects on isomorphic testing and transfer performance of clinical knowledge and clinical reasoning skills as well as evoked learning mechanisms. The study took place in spring 2021 with undergraduate medical students in the scope of a medical trajectory course. Due to Corona-Virus-19 measures participants completed all study activities remotely from home. Results: The authors did not find any learning activity sequence to be superior to the other. However, when looking at the two learning activities individually, they found that problem-solving in computer-based virtual environment simulations and direct instruction might be equally effective for learning content knowledge. Nevertheless, problem-solving in computer-based virtual environment simulations with formative feedback might be more effective for learning clinical reasoning skills than mere instruction. Conclusions: The findings indicate that problem-solving in computer-based virtual environment simulations might be more effective for learning clinical reasoning skills than mere theoretical instruction. The present study has a high level of ecological validity because it took place in a realistic setting where students had to perform all learning and testing tasks autonomously.

Prepubescent Female Genital Examination Images: Evidence-Informed Learning Opportunities

OBJECTIVES

To determine diagnoses and image features that are associated with difficult prepubescent female genital image interpretations.

DESIGN AND SETTING

This was a mixed-methods study conducted at a tertiary care pediatric center using images from a previously developed education platform.

PARTICIPANTS

Participants comprised 107 medical students, residents, fellows, and attendings who interpreted 158 cases to derive case difficulty estimates.

INTERVENTIONS

This was a planned secondary analysis of participant performance data obtained from a prospective multi-center cross-sectional study. An expert panel also performed a descriptive review of images with the highest frequency of diagnostic error.

MAIN OUTCOME MEASURES

We derived the proportion of participants who interpreted an image correctly, and features that were common in images with the most frequent diagnostic errors.

RESULTS

We obtained 16,906 image interpretations. The mean proportion correct scores for each diagnosis were as follows: normal/normal variants 0.84 (95% confidence interval [CI] 0.82, 0.87); infectious/dermatology pathology 0.59 (95% CI 0.45, 0.73); anatomic pathology 0.61 (95% CI 0.41, 0.81); and, traumatic pathology 0.64 (95% CI 0.49, 0.79). The mean proportion correct scores varied by diagnosis (P < .001). The descriptive review demonstrated that poor image quality, infant genitalia, normal variant anatomy, external material (eg, diaper cream) in the genital area, and nonspecific erythema were common features in images with lower accuracy scores.

CONCLUSIONS

A quantitative and qualitative examination of prepubescent female genital examination image interpretations provided insight into diagnostic challenges for this complex examination. These data can be used to inform the design of teaching interventions to improve skill in this area.

Image interpretation: Learning analytics-informed education opportunities

OBJECTIVES

Using a sample of pediatric chest radiographs (pCXR) taken to rule out pneumonia, we obtained diagnostic interpretations from physicians and used learning analytics to determine the radiographic variables and participant review processes that predicted for an incorrect diagnostic interpretation.

METHODS

This was a prospective cross-sectional study. A convenience sample of frontline physicians with a range of experience levels interpreted 200 pCXR presented using a customized online radiograph presentation platform. Participants were asked to determine absence or presence (with respective location) of pneumonia. The pCXR were categorized for specific image-based variables potentially associated with interpretation difficulty. We also generated heat maps displaying the locations of diagnostic error among normal pCXR. Finally, we compared image review processes in participants with higher versus lower levels of clinical experience.

RESULTS

We enrolled 83 participants (20 medical students, 40 postgraduate trainees, and 23 faculty) and obtained 12,178 case interpretations. Variables that predicted for increased pCXR interpretation difficulty were pneumonia versus no pneumonia (β = 8.7, 95% confidence interval [CI] = 7.4 to 10.0), low versus higher visibility of pneumonia (β = -2.2, 95% CI = -2.7 to -1.7), nonspecific lung pathology (β = 0.9, 95% CI = 0.40 to 1.5), localized versus multifocal pneumonia (β = -0.5, 95% CI = -0.8 to -0.1), and one versus two views (β = 0.9, 95% CI = 0.01 to 1.9). A review of diagnostic errors identified that bony structures, vessels in the perihilar region, peribronchial thickening, and thymus were often mistaken for pneumonia. Participants with lower experience were less accurate when they reviewed one of two available views (p < 0.0001), and accuracy of those with higher experience increased with increased confidence in their response (p < 0.0001).

CONCLUSIONS

Using learning analytics, we identified actionable learning opportunities for pCXR interpretation, which can be used to allow for a customized weighting of which cases to practice. Furthermore, experienced-novice comparisons revealed image review processes that were associated with greater diagnostic accuracy, providing additional insight into skill development of image interpretation.

Undergraduate Radiology Education During the COVID-19 Pandemic: A Review of Teaching and Learning Strategies [Formula: see text]

The Coronavirus disease 2019 (COVID-19) pandemic has altered how medical education is delivered, worldwide. Didactic sessions have transitioned to electronic/online platforms and clinical teaching opportunities are limited. These changes will affect how radiology is taught to medical students at both the pre-clerkship (ie, year 1 and 2) and clinical (ie, year 3 and 4) levels. In the pre-clerkship learning environment, medical students are typically exposed to radiology through didactic lectures, integrated anatomy laboratories, case-based learning, and ultrasound clinical skills sessions. In the clinical learning environment, medical students primarily shadow radiologists and radiology residents and attend radiology resident teaching sessions. These formats of radiology education, which have been the tenets of the specialty, pose significant challenges during the pandemic. This article reviews how undergraduate radiology education is affected by COVID-19 and explores solutions for teaching and learning based on e-learning and blended learning theory.