Effectiveness of a Teaching Session on Interpreting Common Orthopaedic Radiographs at a Major Trauma Centre

Background  Accurate interpretation of common orthopaedic radiographs is an important skill for junior clinicians working in emergency, trauma, and orthopaedic settings. Missed fractures and unrecognised malalignment remain important causes of diagnostic error, particularly in busy major trauma centres where the first review of imaging may take place before a formal radiology report is available. Structured, case-based teaching may improve both diagnostic accuracy and clinician confidence, but local educational interventions should be evaluated using objective measures. Methods  We conducted a prospective single-centre educational quality improvement study at a UK major trauma centre between January 2025 and March 2026. Foundation doctors, core trainees, physician associates, clinical fellows, and other early-career clinicians rotating through trauma and orthopaedics or the emergency department were invited to attend a 45-minute senior-led teaching session on a systematic approach to common orthopaedic radiographs. Participants completed a 25-item image-based assessment and a 0-10 confidence rating scale immediately before and after the session. Those who consented to follow-up were also invited to complete a voluntary six-week retention assessment. The primary outcome was change in total radiograph interpretation score. Secondary outcomes included domain-specific accuracy, self-rated confidence, and the frequency of predefined critical errors. Results  Forty-eight clinicians completed paired pre- and post-session assessments. The mean test score increased from 58.9% (SD 11.3) before teaching to 82.1% (SD 11.3) immediately after teaching, giving a mean paired improvement of 23.2 percentage points (95% CI: 20.8-25.6; p < 0.001; Cohen's d_z = 2.83). Mean self-rated confidence increased from 4.5 ± 1.6 before teaching to 7.7 ± 1.8 after teaching. Improvements were seen across fracture detection, recognition of alignment and dislocation, hardware assessment, assessment of view adequacy, and escalation planning. Thirty-four participants completed the six-week retention assessment, with a retained mean score of 76.8% (SD 11.7). Critical errors fell from 146 before teaching to 48 after teaching, representing a 67.1% relative reduction. Conclusions  A single structured, interactive orthopaedic X-ray teaching session was associated with significant immediate improvements in image interpretation accuracy and self-rated confidence among early-career clinicians at a major trauma centre, with partial retention at six weeks. Embedding short, recurring, case-based radiograph teaching into trauma and orthopaedic induction may be a practical way to support diagnostic safety. Further multicentre studies using validated image banks and patient-linked diagnostic outcomes are warranted.