The University of Chicago Medicine is schooling internal medicine trainees on “Imaging Wisely” in the hope of cutting back on inappropriate use.

Overutilization is an increasing concern in the U.S., with half of all cross-sectional imaging possibly providing no useful information for patient management, experts wrote June 16 in JACR. To address this concern, UChicago piloted a training program with internal medicine interns, introducing them to principles of proper ordering via the American College of Radiology Appropriateness Criteria.

Analyzing survey data after the pilot revealed marked gains, with broader implications for the field of medicine.

“In summary, our curriculum led to improved knowledge, attitudes and utilization of the ACR AC,” corresponding author Carina W. Yang, MD, and colleagues concluded. “Expanding this curriculum longitudinally, requiring the curriculum universally for trainees, implementing decision support tools, and partnering with national societies could improve judicious utilization of diagnostic imaging.”

The curriculum was developed by a multidisciplinary team that included an internal medicine specialist, radiology faculty and trainees in both specialties, combining rads’ content expertise with IM’s contextual know-how. It also used principles of cognitive learning, including self-reflection. Between each of the two sessions, residents completed “case vignettes” via the ACR’s Radiology-Teaches portal.

Yang et al. administered surveys both before the curriculum was implemented in 2017-2018 and immediately afterward. The researchers assessed knowledge based on six multiple-choice questions tied to the vignettes. The analysis zeroed in on lower back pain, pinpointed by Choosing Wisely as a symptom that often leads to unnecessary imaging.

Following the intervention, learners demonstrated improved and sustained knowledge about high-value imaging. Average scores for appropriate ordering trended significantly higher after the curriculum was implemented, and trainees referenced ACR Appropriateness Criteria more frequently during open-book assessments.

“Post-curriculum, more residents reported comfort with knowledge of exam costs and discussing costs with patients, and rated the value of the ACR AC more highly,” the authors noted.

Prior to the change, 35% of residents said they were unaware of the criteria. But 78% said they referenced it at least once per month during clinical care duties afterward. However, the curriculum did not appear to produce significant changes in image ordering for lower-back pain, the authors reported.

“Our novel curriculum was well-received and improved knowledge, attitudes and self-reported behavior change in IM trainees,” Yang et al. wrote. “We believe our study showed knowledge retention due to its emphasis on reflective practice; we promoted the ACR AC as an educational tool that learners can continually reference to compare their own clinical practice to recommendations. Given our curriculum’s use of freely accessible online resources, associated costs are low, aiding in broad dissemination. Our curriculum could also be easily adapted for other specialties.”

Read more in the Journal of the American College of Radiology at the link below.