[Competence of senior medical students in diagnosing tuberculosis based on chest X-rays]

Competency in Chest Radiography Interpretation by Junior Doctors and Final Year Medical Students at a Teaching Hospital

Background

Chest radiography (CXR) is a widely used imaging technique for assessing various chest conditions; however, little is known on the medical doctors' and medical students' level of skills to interpret the CXRs. This study assessed the residents, medical officers, house officers, and final year medical students' competency in CXRs interpretation and how the patient's clinical history influences the interpretation.

Methods

We conducted a cross-sectional study in the Cape Coast Teaching Hospital in the Central Region of Ghana among 99 nonradiologists, comprising 10 doctors in residency programmes, 18 medical officers, 33 house officers, and 38 final year medical students. The data collection was done with a semistructured questionnaire in two phases. In phase 1, ten CXRs were presented without patient's clinical history. Phase 2 involved the same ten CXRs presented in the same order alongside the patient's clinical history. Participants were given 3 minutes to interpret each image. Median and interquartile ranges were used to describe continuous variables, while frequencies and percentages were used to describe categorical variables. Test of significant difference and association was conducted using a Wilcoxon rank-sum test/Kruskal-Wallis test and chi-square (X ²) test, respectively.

Results

The average score for interpreting CXRs was 7.0 (IQR = 5-8) and 4.0 (IQR = 3-4), when CXRs were, respectively, presented with and without clinical history. No significant difference was seen in average scores regarding the levels of formal training. Without clinical history, only 40.0% of residents, 22.2% of medical officers, 24.2% of house officers, and 13.2% of medical students correctly interpreted CXRs, while more than 75% each of all categories correctly interpreted CXRs when presented with clinical history. However, all participants had difficulties in identifying CXR with pneumothorax (27.3% vs. 30.3%), pneumomediastinum or left rib fracture (8.1% vs. 33.3%), and lung collapse (37.4% vs. 37.4%) in both situations, with and without patient clinical history.

Conclusion

The patient's clinical history was found to greatly influence doctors' competence in interpreting CXRs. We found a gap in doctors' and medical students' ability to interpret CXRs; hence, the development of this skill should be improved at all levels of medical training.

Survey of practitioners' competency for diagnosis of acute diseases manifest on chest X-ray

Background

Chest X-ray (CXR) is a common imaging modality that could impact immediate decision-making for acute chest pathologies. We sought to examine the non-radiologists proficiency of diagnosing acute pathologies manifest on CXR.

Methods

We selected 9 clinical vignettes, each associated with a CXR, wherein only a single acute chest pathology was manifest. We also added a low-risk vignette associated with a normal CXR. We built an electronic survey with the CXR-embedded vignettes and also inquired about the participants’ confidence in the diagnosis, and prior exposure to the topics. We distributed the survey to senior medical students and general practitioners (GPs) in Tehran, Iran. We scored each correct answer per each vignette as 1 and each incorrect answer as 0; leading into a sum score from 0 to10 for the entire survey for each participant.

Results

Of the 136 candidates, 100 had legible survey results (67 medical students and 33 GPs). The overall score (mean [standard error]) was 3.57 [0.20], with no significant difference between the students and GPs (P = 0.15). The lowest rate of correct response occurred for acute respiratory distress syndrome (8%), foreign body (12%), and normal CXR (15%), while the best-answered vignettes were diaphragmatic herniation (77%) and pneumoperitoneum (67%). Self-reported confidence was associated with correct response for pneumoperitoneum, tension pneumothorax, and pulmonary edema (P < 0.05 for all).

Conclusions

Diagnostic proficiency of practitioners for acute chest pathologies in our study was poor, including for distinction of a normal CXR. Such dramatic knowledge deficiencies for common or life-threatening chest pathologies should be prioritized in the educational and continuous education curricula. Secure electronic tools for transferring the CXRs to specialists in case of acute pathologies would be an interim pragmatic alternative.

Electronic supplementary material

The online version of this article (doi:10.1186/s12880-017-0222-8) contains supplementary material, which is available to authorized users.

An overview of recently published medical papers in Brazilian scientific journals

A brief review intended as information to the readership of Clinics on papers recently published under various medical headings in Brazilian scientific journals recently indexed or about to be indexed in ISI-THOMSON Journal Citation Reports. Journals covered in this review are Acta Ortopédica Brasileira, Arquivos Brasileiros de Cardiologia, Jornal Brasileiro de Pneumologia, Revista Brasileira de Cirurgia Cardiovascular and Revista da Associação Médica Brasileira.