Radiology resident discrepancy rates low, improve over time

Preliminary reports from on-call radiology residents have a low rate of major discrepancies when compared to corresponding faculty reporting, according to a new study published in the Journal of the American College of Radiology.

Authors Brent D. Weinberg, MD, PhD, of The University of Texas Southwestern Medical Center, and colleagues showed discrepancy rates varied based on modality and continued to fall with residents’ experience level.

Many training programs within the medical system have been modified in recent years to increase supervision and decrease trainee independence in an effort to minimize negative effects on patient care. Radiology departments are no exception, with many implementing policies of 24-hour faculty interpretation of resident studies and delayed independent call-taking experiences for radiology residents.

Weinberg and colleagues wanted to gauge the accuracy of preliminary reports from residents as part of an independent call system with remote supervision by faculty. To do so, they evaluated a total of 416,413 independently reported studies from a county hospital with a large emergency department from October 2009 to December 2013.

Of those studies, only 1.7 percent were found to have major discrepancies, with 0.2 percent determined to have a significant negative impact on patient care. The results also showed that experience and modality were the variables most likely to affect discrepancy rates, with the most significant improvements coming between the third and fifth year of residency (PGY-3: 1.8 percent, PGY-4: 1.7 percent, PGY-5: 1.5 percent). The highest rates of discrepancy arose in studies utilizing MR (3.7 percent), followed by CT (2.4 percent), radiographs (1.4 percent) and ultrasound (0.6 percent), but were still within the range of variation present in faculty reporting.

“Although recommendations for 24-hour faculty supervision of radiology residents will continue, this study and others make clear that radiology resident interpretation error rates are low and have a minimal adverse impact on patient care,” wrote Weinberg et al. “Additionally, there is definitive improvement in the quality of radiology resident interpretations throughout their on-call experience.”

It is important, however, not to delay this experience too long: The authors suggested that exposing radiologists to independent on-call decision-making in the latter stages of residency could reduce the risk of adverse patient outcomes that may otherwise occur within the first years of professional radiology practice.