Radiology resident competency in diagnosing non-traumatic musculoskeletal conditions: A simulation-based assessment...

Area of Science:

• Radiology
• Musculoskeletal Imaging
• Medical Education

Background:

• Non-traumatic musculoskeletal (MSK) pathologies present diagnostic challenges in radiology.
• The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is used to assess resident performance.
• Historically, resident performance on specific MSK cases in WIDI SIM has been suboptimal.

Purpose of the Study:

• To evaluate radiology resident performance in diagnosing four specific non-traumatic MSK pathologies using the WIDI SIM.
• To identify areas of weakness in resident interpretation of challenging MSK cases.

Main Methods:

• Retrospective analysis of WIDI SIM data from 351 residents (R1-R4) between 2015-2021.
• Included four non-traumatic MSK cases: shoulder/hip septic arthritis/osteomyelitis, acetabular neoplasm, and Legg-Calve-Perthes disease.
• Scoring rubric assessed diagnostic accuracy; errors categorized as observational (missed findings) or interpretive (incorrect conclusion).

Main Results:

• Overall diagnostic scores for the four MSK pathologies were low across all resident levels.
• Hip osteomyelitis showed a statistically significant difference in performance across postgraduate years (p=0.0063).
• Observational errors (missed findings) were more frequent than interpretive errors.

Conclusions:

• Radiology residents face difficulties diagnosing non-traumatic MSK conditions in simulated emergent settings.
• Missed imaging findings represent the primary source of diagnostic errors.
• Targeted training, including case review and systematic search protocols, is crucial for improving MSK diagnostic competency.