Radiology Training in Emergency Medicine Residency as a Predictor of Confidence in an Attending

At present, there exists no standardized curriculum for the interpretation of plain film radiography for emergency medicine (EM) training programs that have been adopted by an accrediting body. Education geared towards plain film interpretation is highly variable and institutionally specific. This highly variable education is dependent upon institutional resources, availability of real-time radiology interpretations, formalized radiology instruction, in addition to self-directed study. Furthermore, it is unclear whether the presence of a radiology residency program at the same institution will positively or negatively impact the radiographic education of the EM resident. In a community practice setting, EM providers may encounter several scenarios in which they must rely on their own independent interpretations during radiology coverage gaps. The goal of this study was to assess whether the amount of formal radiology training correlates with the confidence in the interpretation of radiographs following residency graduation early in a junior attending's career.

A survey study with 14 questions was distributed to EM attendings utilizing social media. Over a two-month period, 218 responses were obtained and statistical analysis was performed utilizing a chi-square test. Three survey questions with multi-variable answers were compressed into two variables for statistical analysis.

Only 30% of survey participants indicated universal radiology coverage; 30% also responded that they did not feel prepared to interpret plain film radiographs upon residency completion. There were four statistically significant factors associated with higher confidence in interpreting radiographs upon residency graduation. Physicians were more likely to feel confident in reading radiographs if they (1) graduated from a program with no radiology residency present, (2) if their residency was located in a non-tertiary training facility, (3) if most of their radiograph learning occurred on shift and (4) if they made clinical decisions based on their own interpretations frequently. 40% of physicians reported they were more confident currently in interpreting radiographs than when they first completed residency.

Steps should be taken to ensure that graduating residents are being prepared to interpret plain film radiographs as many providers will be required to do so independently in future practice. Emphasis should be focused towards on-shift teaching of these skills. Graduates at greatest risk of lower confidence train at large tertiary care centers with concomitant training of radiology residents. By emphasizing on off-shift strategies for the interpretation of plain film radiographs, residents will build confidence and develop the ability to perform these necessary skills early in one's career.