Educational interventions to improve screening mammography interpretation: a randomized controlled trial.
OBJECTIVE
The objective of our study was to conduct a randomized controlled trial of educational interventions that were created to improve performance of screening mammography interpretation.


METHODS
We randomly assigned physicians who interpret mammography to one of three groups: self-paced DVD, live expert-led educational seminar, or control. The DVD and seminar interventions used mammography cases of varying difficulty and provided associated teaching points. Interpretive performance was compared using a pretest-posttest design. Sensitivity, specificity, and positive predictive value (PPV) were calculated relative to two outcomes: cancer status and consensus of three experts about recall. The performance measures for each group were compared using logistic regression adjusting for pretest performance.


RESULTS
One hundred two radiologists completed all aspects of the trial. After adjustment for preintervention performance, the odds of improved sensitivity for correctly identifying a lesion relative to expert recall were 1.34 times higher for DVD participants than for control subjects (95% CI, 1.00-1.81; p = 0.050). The odds of an improved PPV for correctly identifying a lesion relative to both expert recall (odds ratio [OR] = 1.94; 95% CI, 1.24-3.05; p = 0.004) and cancer status (OR = 1.81; 95% CI, 1.01-3.23; p = 0.045) were significantly improved for DVD participants compared with control subjects, with no significant change in specificity. For the seminar group, specificity was significantly lower than the control group (OR relative to expert recall = 0.80; 95% CI, 0.64-1.00; p = 0.048; OR relative to cancer status = 0.79; 95% CI, 0.65-0.95; p = 0.015).


CONCLUSIONS
In this randomized controlled trial, the DVD educational intervention resulted in a significant improvement in screening mammography interpretive performance on a test set, which could translate into improved interpretative performance in clinical practice.
1 Department of Family Medicine and Department of Radiology, University of Vermont, Health Promotion Research, 1 S Prospect St, Rm 4426, Burlington, VT 05401-3444.
Berta M
BM
Geller
Andy
A
Bogart
Patricia A
PA
Carney
Edward A
EA
Sickles
Robert
R
Smith
Barbara
B
Monsees
Lawrence W
LW
Bassett
Diana M
DM
Buist
Karla
K
Kerlikowske
Tracy
T
Onega
Bonnie C
BC
Yankaskas
Sebastien
S
Haneuse
Deirdre
D
Hill
Matthew G
MG
Wallis
Diana
D
Miglioretti
D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003194:Computer-Assisted Instruction / Q000379:methods / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000706:statistics & numerical data*; D011871:Radiology / Q000193:education*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States