Use of a Standardized Learning Tool to Enhance Residents Ability to Diagnose Pneumonia on Chest Radiographs

Abstract

Objective: Resident doctors are required to gain skills in reading chest X-rays. There have been few studies regarding the effectiveness of resident education in reading chest X-ray. Here, we examined the effectiveness of an educational method we developed for radiographic interpretation. Methods: A standardized lecture about diagnosis of pneumonia on chest X-ray was developed in 2012 and given to all first-year postgraduate (PGY1) residents at St Luke’s International Hospital in Japan. The examination was composed of 30 chest X-ray images representing either no disease or pneumonia. For pneumonia films, respondents identify disease location from a choice of 6 answers (right upper lobe, right middle lobe, right lower lobe, left upper segment, left lingular segment and left lower lobe). Total scores were compared before and after the intervention, and again 1 year later. Results: Twenty-one residents completed the 1-year follow-up exam. The overall percentage of correct answers for pre-lecture, post-lecture, and 1-year exams was 58%, 72% and 62% respectively. When we analyzed the data by disease location between pre- and post- educational intervention, percentage of correct answers increased only for images of left lower lobe (LLL) disease, rising from 61% to 88 % (p<0.01), and right middle lobe (RML), increasing from 61% to 88 % (p=0.015). For RML disease images, the percentage of correct answers remained 64 % after 1 year (p=0.007). Conclusion: A standardized lecture on chest X-ray reading enhanced residents’ ability to diagnose pneumonia. While improvements were short-lived, the intervention was particularly effective for difficult-to-diagnose areas such as right middle lobe disease.