A Performance-Based Competency Assessment of Pediatric Chest Radiograph Interpretation Among Practicing Physicians

Area of Science:

• Medical Imaging
• Radiology
• Pediatric Imaging

Background:

• Limited data exists on the interpretation skills of practicing physicians regarding pediatric chest radiographs (pCXR).
• Understanding baseline interpretation proficiency and learning curves is crucial for improving diagnostic accuracy in pediatric radiology.

Purpose of the Study:

• To assess the baseline interpretation skill of practicing physicians on pCXR.
• To determine the number of pCXR cases needed to reach a performance benchmark.
• To identify specific diagnoses that present the greatest interpretation challenges.

Main Methods:

• Physicians interpreted 434 pCXR cases online until achieving 85% accuracy, sensitivity, and specificity.
• Interpretation difficulty was quantified using item response theory.
• Challenging diagnoses were identified by analyzing the most difficult cases.

Main Results:

• 240 physicians completed 56,833 interpretations; initial accuracy was 68.9%.
• Median cases to reach benchmark: 102 (IQR 69-176).
• Most difficult cases included normal pCXR (39.2%), lobar pneumonia (32.3%), trauma, cardiac, hilar, and diaphragmatic pathologies.

Conclusions:

• Practicing physicians misdiagnosed approximately one-third of pCXR at baseline.
• Significant variability exists in the number of cases required to achieve proficiency.
• Specific diagnoses, such as normal pCXR and lobar pneumonia, require targeted educational interventions.