title: Using focused missed-case conferences to reduce discrepancies in musculoskeletal studies interpreted by residents on call.
abstract: OBJECTIVE
  The purpose of this study is to determine whether focused missed-case conferences can significantly reduce the number of major discrepancies in musculoskeletal imaging studies interpreted by residents on call.
  
  
  METHODS
  A review of major discrepancies in musculoskeletal conventional radiography imaging studies interpreted by radiology residents and fellows on call from July 2008 to July 2009 revealed 31 common and important musculoskeletal injuries missed or misinterpreted at our institution. These missed cases were presented during focused missed-case conferences from July through October 2009. Only residents attended missed-case conferences.
  
  
  RESULTS
  Over the 12 months before the missed-case conferences, there were 55 resident major discrepancies and 25 fellow major discrepancies, representing 31 common and important missed musculoskeletal injuries. Over the 12 months after the missed-case conferences, there were 18 resident major discrepancies and 21 fellow major discrepancies involving these injuries. This corresponds to a 67% reduction in the number of resident major discrepancies involving the 31 musculoskeletal injuries covered during the missed-case conferences (chi-square p < 0.001). The overall major discrepancy rate for all musculoskeletal conventional radiography studies was 1.19% for residents and 1.55% for fellows (not significant) before the missed-case conferences and 0.87% for residents and 1.46% for fellows (p < 0.05) after the missed-case conferences. During this time, fellows missed more musculoskeletal injuries related to the topics discussed during missed-case conferences (16) compared with residents (8) although fellows read significantly fewer studies overall. This accounted for 0.49% of the 0.59% difference between residents and fellows.
  
  
  CONCLUSIONS
  Focused missed-case conferences are an effective educational intervention to significantly reduce the number of major discrepancies in radiology resident interpretation of musculoskeletal imaging studies on call.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA. jason. itri@uphs.upenn.edu
authors.forename: Jason N
authors.initials: JN
authors.lastname: Itri
authors.forename: Hyunseon Christine
authors.initials: HC
authors.lastname: Kang
authors.forename: Sriyesh
authors.initials: S
authors.lastname: Krishnan
authors.forename: Diane
authors.initials: D
authors.lastname: Nathan
authors.forename: Mary H
authors.initials: MH
authors.lastname: Scanlon
mesh_terms: D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011785:Quality Assurance, Health Care; D011859:Radiography; D011871:Radiology / Q000193:education* / Q000592:standards*; D012984:Software; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*