Radiology resident proficiency in identifying misplaced lines, tubes, and devices: a simulation-based study using...

Area of Science:

• Medical Imaging and Radiology
• Medical Education
• Critical Care Medicine

Background:

• Accurate placement of medical devices is vital in critical care settings to prevent severe patient complications.
• Radiology residents play a key role in interpreting diagnostic images to confirm device placement.

Purpose of the Study:

• To evaluate the proficiency of radiology residents in identifying four specific critical misplacements of medical devices.
• To assess the effectiveness of the Wisdom in Diagnostic Imaging Simulation (WIDI SIM) in evaluating resident performance.

Main Methods:

• A retrospective analysis of 1,102 WIDI SIM responses from radiology residents (2010-2022) was performed.
• The simulation included cases of misplaced endotracheal tubes, intrauterine devices, peripherally inserted central catheters, and umbilical venous catheters.
• Resident interpretations were scored, and errors were categorized as observational or interpretive.

Main Results:

• Residents' average scores across all cases were below the acceptable threshold of 7 points.
• Observational errors, or failure to identify misplacement, were the predominant error type.
• Effective report rates were notably low, ranging from 19% for peripherally inserted central catheters to 58% for endotracheal tubes.

Conclusions:

• Significant gaps exist in radiology residents' ability to accurately identify critical medical device misplacements.
• Suboptimal performance, largely due to observational errors, highlights the need for focused educational interventions.
• Improving resident proficiency in recognizing these misplacements is crucial for enhancing patient safety in emergency radiology.