Rationale and Objectives
The Resident Review Committee (RRC) recently changed the policy concerning first-year resident call. Our study is intended to evaluate whether the additional 6 months of training before a resident’s first call made a significant difference in the resident’s ability to provide patient care. To evaluate this, we assessed the discrepancy rates between preliminary interpretations made by residents and final reports by attendings.
Materials and Methods
All cross-sectional imaging interpreted by on-call residents (5 PM to 8 AM) during the first 6 months of call duties was reviewed for discrepant findings between the preliminary resident report and the final interpretation by an attending. Only major discrepancies were evaluated. A major discrepancy was defined as a change made to the resident preliminary report by an attending radiologist where a delay in communicating that finding had the potential to negatively affect clinical outcomes. Major discrepancy rates between groups were then compared.
Results
During the second 6 months of the 2008–2009 academic year, first-year residents interpreted 3331 studies. Fifty-nine of those were declared to be discrepancies after an attending over-read, a rate of 1.8%. During the first 6 months of the 2009–2010 academic year, second-year residents interpreted 4649 studies with 49 discrepancies, a rate of 1.0%. This difference is statistically significant ( P = .008).
Conclusions
The recent RRC policy change requiring 6 additional months of training before assuming independent on-call responsibilities has significantly decreased the major discrepancy rate at our institution.
The Resident Review Committee (RRC) has recently changed the policy concerning first-year residents taking call. Radiology residents are now required to complete 12 months of training before taking independent call. This is the second such change in the last 20 years. In 1990, a 6-month training requirement was introduced. The RRC feels that the in-service exam is an indicator of resident readiness for independent call, citing increasing raw scores as proof of improving ability on call .
Two national program surveys that polled program directors and chief residents demonstrated that the change was unpopular, with 66%–70% of respondents against the change . Protests stated that there was no proof that the extra 6 months of training would have a significant impact on patient care, with overall clinically significant discrepancy rates ranging from 0.3% to 10% .
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Materials and methods
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Results
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Table 1
Discrepancy Rates after 6 Months of Training
2008–2009n Discrepancies % Total 3331 59 1.8 Musculoskeletal 483 4 0.08 Neurology 887 7 0.08 Chest 755 9 1.2 Body 1206 32 2.6
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Table 2
Discrepancy Rates after 12 Months of Training
2009–2010n Discrepancies % Total 4649 49 1.0 Musculoskeletal 1056 11 1.0 Neurology 1594 18 1.1 Chest 856 9 1.0 Body 1156 11 1.0
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Table 3
Overall Resident Major Discrepancy Rates
Study Imaging Interpreted No. of Studies Major Discrepancies Our study All cross-sectional 16,043 1% Wechsler Body CT 598 1.2% Yoon Abdominal/pelvis CT 512 2.3% Roszler Cranial CT 289 2.0% Wysoki Cranial CT 419 1.7% Velmahos Trauma CT 383 5.0% Carney Body CT/US 928 0.5% Fillipi Neurologic MRI 361 4.2%
CT, computed tomography; US, ultrasound; MRI, magnetic resonance imaging.
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Discussion
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Table 4
Discrepancy Rates Broken Down by PGY
Study Exams PGY 2 PGY 3 PGY 4 PGY 5 Fellow Our study All cross-sectional 1.8% 1.0% 0.79% 0.48% NA Filippi Neurologic MRI 6.3% 2.8% 3.4% NA NA Ruchman All 1.5% 2.9% 3.3% 2.2% NA Wysoki Head CT 2.4% 0.0% 4.0% NA NA Wechsler Body CT NA 0.0% 7.8% NA 0.7% Erly Head CT 2.0% 1.0% 0.0% 0.0% NA
CT, computed tomography; MRI, magnetic resonance imaging; PGY, postgraduate year.
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Acknowledgment
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