title: Competency in chest radiography. A comparison of medical students, residents, and fellows.
abstract: BACKGROUND
  Accurate interpretation of chest radiographs (CXR) is essential as clinical decisions depend on readings.
  
  
  OBJECTIVE
  We sought to evaluate CXR interpretation ability at different levels of training and to determine factors associated with successful interpretation.
  
  
  METHODS
  Ten CXR were selected from the teaching file of the internal medicine (IM) department. Participants were asked to record the most important diagnosis, their certainty in that diagnosis, interest in a pulmonary career and adequacy of CXR training. Two investigators independently scored each CXR on a scale of 0 to 2.
  
  
  METHODS
  Participants (n=145) from a single teaching hospital were third year medical students (MS) (n=25), IM interns (n=44), IM residents (n=45), fellows from the divisions of cardiology and pulmonary/critical care (n=16), and radiology residents (n=15).
  
  
  RESULTS
  The median overall score was 11 of 20. An increased level of training was associated with overall score (MS 8, intern 10, IM resident 13, fellow 15, radiology resident 18, P<.001). Overall certainty was significantly correlated with overall score (r=.613, P<.001). Internal medicine interns and residents interested in a pulmonary career scored 14 of 20 while those not interested scored 11 (P=.027). Pneumothorax, misplaced central line, and pneumoperitoneum were diagnosed correctly 9%, 26%, and 46% of the time, respectively. Only 20 of 131 (15%) participants felt their CXR training sufficient.
  
  
  CONCLUSIONS
  We identified factors associated with successful CXR interpretation, including level of training, field of training, interest in a pulmonary career and overall certainty. Although interpretation improved with training, important diagnoses were missed.
authors.affiliation: Division of Pulmonary and Critical Care, Beth Israel Medical Center, New York, NY 10010, USA. leisen@gmail.com
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Eisen
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
authors.forename: Abhijith
authors.initials: A
authors.lastname: Hegde
authors.forename: Roslyn F
authors.initials: RF
authors.lastname: Schneider
mesh_terms: D002321:Career Choice; D002983:Clinical Competence; D003625:Data Collection; D004521:Educational Measurement; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D016015:Logistic Models; D008171:Lung Diseases / Q000175:diagnosis; D008297:Male; D015999:Multivariate Analysis; D013902:Radiography, Thoracic; D011871:Radiology / Q000193:education*; D013337:Students, Medical