Radiology residents vs. final-year students: What a difference a year of clinical practice makes

Irish researchers have found that on-the-job training quickly hoists new radiologists’ know-how, at least as regards appropriateness of imaging ordering, well above their competence levels heading into—and even upon completion of—their final year of medical school.

Academic Radiology published the findings online Jan. 10.

Led by Brian Moloney, MB, MCh, of Galway University Hospital and the National University of Ireland, the research team extracted 12 scenarios from the American College of Radiology’s Appropriateness Criteria (ACR-AC).

Selecting one topic from each of the ACR-AC’s 10 sections in the diagnostic section and two from the interventional section, they created a questionnaire and sent it 160 participants affiliated with the Galway hospital.

The distribution list was broken into three subsets.

Group A (n = 72) was composed of medical students at the beginning of their final year in school. Group B (n = 53) was composed of medical students at the end of their final year. Group C (n = 35) was composed of residents at the end of their first year of clinical practice.

Here’s a sample question from the orthopedic section of the questionnaire: “What is the most appropriate imaging investigation for an adult who has turned heavily on his ankle, is unable to bear weight immediately after the injury, and has point tenderness over the medial malleolus?” (Answer choices: No imaging required; x-ray ankle [AP, lateral and mortise]; CT ankle without contrast; MRI ankle; or ultrasound ankle.)

The researchers found that Group C performed significantly better than group A and group B, and there was no statistical difference in the mean scores achieved by group A and group B.

To the point, Group C’s mean score of correct answers was 90.9 ± 15, compared with 80.3 ± 15.6 for Group A and 80.6 ± 14.9 for Group B.

An especially wide gap turned up in the section on interventional radiology, where the medical students in both those groups scored just 14 percent and 19 percent correct versus 66 percent for the practicing residents.

Exposure to radiology in the clinical setting “has a positive impact on student learning, with residents achieving high scores in our objective assessment,” Moloney et al. write in their discussion. “This raises the possibility that patients managed by residents in the months directly following medical school may be at higher risk of inappropriate imaging or unnecessary radiation than patients managed in the latter half of the doctor's first year of clinical practice.”

The authors recommend “a more sustained involvement of education on appropriate imaging and greater importance being placed on resources like the ACR-AC into undergraduate education” as ways to improve rates of proper imaging utilization, “with the ultimate positive effect of reduced misuse of hospital resources and improved patient care.”