Online survey of radiologic ordering practices by pediatric trainees

Area of Science:

• Medical Imaging
• Pediatric Residency Education
• Clinical Decision-Making

Background:

• The American College of Radiology (ACR) developed Appropriateness Criteria to guide appropriate imaging study selection.
• Understanding pediatric residents' adherence to these criteria is crucial for optimizing patient care.

Purpose of the Study:

• To compare the imaging ordering practices of pediatric residents with the ACR Appropriateness Criteria.
• To assess resident knowledge and application of established imaging guidelines.

Main Methods:

• A multiple-choice questionnaire with 10 clinical scenarios from ACR Appropriateness Criteria was developed.
• The survey was administered to pediatric residents (postgraduate years 1-3) at two major children's hospitals.
• Resident responses were compared against the ACR Appropriateness Criteria.

Main Results:

• Response rates were 52% (39/75) from Montefiore and 59% (41/69) from Columbia.
• Across postgraduate years, residents answered an average of 4.1 to 4.5 questions incorrectly.
• No significant difference in incorrect answers was observed between postgraduate years.

Conclusions:

• Pediatric residents recognize the importance of imaging but frequently order studies without radiologist consultation.
• Individual training experiences influence residents' imaging order decisions.
• Radiologists should implement uniform, case-based didactic sessions to enhance residents' imaging decision-making skills.