Pulmonary embolism teaching file: a simple pilot study for rapidly increasing pulmonary embolism recognition among...

Chest radiographs can be demanding, making this an area of focus during most first-year resident chest rotations. This often comes at a cost of cross-sectional imaging, and new residents are often not initially comfortable with reading chest computed tomographic angiograms (CTAs) for pulmonary embolisms (PEs). We created a teaching file of CTAs to improve the detection of PEs.

For initial testing, we used videos of 25 cases, which played for 90 seconds (to allow multiple passes) to residents with and without call experience. The presence and location of PEs and the readers' confidence scores were recorded. After initial testing, first-year residents without call experience were given 20 separate known positive CTA videos to scroll through on their own. The goal of this was to allow for individual review and development of individual search strategies. A second testing was done with all levels of residents with the same initial 25 cases, re-randomized to evaluate for improvement.

Initially, first-year residents without call experience identified an average of 14.7 of 18 examinations positive for PEs (versus 15.8 for more senior residents; P < .04). After reviewing the 20 known positive cases, the first-year residents improved, averaging 16.6 (versus 14.7 earlier; P < .01).

We created a fast, simple way to expose novice residents to CTA examinations and increase their accuracy in identifying PEs. After using a teaching file, the ability to recognize PEs improved significantly, and scores were no longer significantly different from those of residents with call experience.