Educational impact of faculty review on radiology residents' radiographic interpretations.

The objective of this study was to analyze the improvements in film reading performance made by radiology residents during their first six months of training. Five first-year residents and eight radiologic technology students each interpreted two of three matched sets of 39 films under two conditions. One set's readings were reviewed by a staff radiologist, while the other's were unreviewed. Six months later, each observer read all three sets. After the first six months of training, residents improved their reporting of findings. There was less improvement in technologists' readings. Review and instruction by staff, both in the laboratory and daily work settings, appeared to contribute to improved performance. Accuracy of residents' final diagnosis did not improve significantly. We conclude that a training system in which residents' film interpretations are reviewed by staff can lead to improved resident performance. When studied in a longitudinal fashion, these improvements are detectable within six months. This teaching system is used in many radiology departments.

Resident film interpretations and staff review.

In this department 22% of examinations are interpreted independently by residents outside of normal hours. Staff radiologists review these studies in a process designed to train residents and assure appropriate radiologic consultation. The resident's written reports on 2,619 examinations were analyzed before and after staff review. Each film review session lasted an average of 1.1 hr. Potential changes were discussed in 9.1% of cases and mandated in 6.3%. About two-thirds of corrections were important enough to influence patient care. Correction rates declined significantly between the first and second/third years of residency; the proportion of clinically important changes also decreased. Omissions (false-negatives) were much more common than overcalls (false-positives). Residents correctly interpreted 89% of abnormal films and 96% of normal radiographs. Staff review resulted in a net improvement in interpretation of 4% of cases initially read by first-year residents and 2% by second- and third-year. The film review process provides opportunities for close resident-staff interaction and teaching and also ensures appropriate final reports.

Radiology department management system: technologists' costs.

We developed a series of management reports to compare actual costs against expected costs for radiology departments on a more detailed level than previously available. We first developed labor standards for the most commonly employed diagnostic examinations and showed that increased patient complexity (resulting from, for example, immobility, precautions status, etc.) also increased the examination times up to 2.6-fold compared with the time required for average patients. Using labor standards and budgeted and actual volumes of average and complex patients, we calculated four types of variances: volume variance, examination mix variance, patient complexity variance, and technologist efficiency variance. Monitoring the technologist efficiency variance over time could be one key piece of information for improving departmental productivity.