Influence of Residency Discipline and Seniority on Musculoskeletal Radiographs Interpretation Accuracy: A Multicenter Study
2Division of Radiology, Tel Aviv Medical Center, Israel
3Division of Orthopedics, Soroka University Medical Center, Israel
4Division of Orthopedic Surgery, Rambam Healthcare Campus, Israel
Purpose:
To evaluate and compare diagnosis accuracy and level of confidence (LOC) of common MSK X-rays (XR) between residency disciplines and seniority.
Methods:
This multi-center study included orthopedic surgery, emergency medicine (EM),and radiology residents, who were evaluated through a 24-item test set consisting of common MSK XR. Residents were classified as "junior" or “senior” according to post graduate year per residency. For each case, residents were asked to answer whether the radiograph shows normal or pathological findings (success rate); what is the diagnosis (diagnosis accuracy); and their LOC. Residents’ answers were analyzed according to residency discipline and seniority and evaluated compared to an experts’ consensus.
Results:
A total of 100 residents (62% juniors) participated in this study. Fifty-four (54.0%) were orthopedic surgeons, 29 (29.0%) were EM residents and 17 (17.0%) were radiologists. The entire cohort overall success rate was 88.5%. The overall mean success rates for orthopedic, EM and radiology residents were 93.2%, 82.8% and 83.3%, respectively and significantly different (p<0.0001). Senior orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to junior residents (p=0.001 and p=0.03, respectively). Orthopedic residents had significantly higher overall cumulative LOC compared with radiology residents (p=0.005) and EM residents (p<0.001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p<0.001).
Conclusion:
Orthopedic residents presented higher confidence and diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on LOC and diagnosis accuracy. The development of an educational program on MSK XR that will address common pitfalls and misdiagnosis is necessary to enhance the competency of physicians handling MSK XR in their daily practice.