Opportunities for targeted education: Critical neuroradiologic findings missed or misinterpreted by residents and fellows

Joseph H. Huntley, Marco Carone, David Mark Yousem, Lukasz S. Babiarz

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. We reviewed neuroradiology cases in which a resident or fellow missed a significant finding, to identify potential areas of deficiency that could be strengthened through targeted education. MATERIALS AND METHODS. Included in the study were all neuroradiology reports from 2011 through 2013 that were marked with an electronic flag to indicate a significant modification between the preliminary and final versions. The reports were examined to determine whether a critical finding (CF) or a non-CF was missed, with the use of a hospitalapproved list of 17 neuroradiology CFs. Results were analyzed for all trainees. RESULTS. A total of 978 modified reports were found among reports from 225,628 neuroradiology examinations. Of these modified reports, 891 (91.1%) contained an addendum that identified the discrepancy: 658 (73.8%) contained a CF,192 (21.7%) contained a non-CF, and 41 (4.6%) were changed from containing a CF to not containing a CF. A total of 725 missed CFs were found in the 658 modified reports. The CF miss rate for all trainees was 6.0% (95% CI, 5.6-6.4%), whereas that for residents was 8.6% and that for fellows was 4.8%. Residents missed hydrocephalus, intracranial pressure or edema, new hemorrhage, and new infarction more frequently than did fellows. The five most frequently missed CFs were congenital variation, infection, misplaced hardware, a new or enlarging mass, and vascular abnormality. CONCLUSION. Our trainees' overall CF miss rate was 6.0%. Five CFs had miss rates of approximately 10% or more, and residents missed four of the CFs more frequently than did fellows. With the use of these data, our curriculum could potentially be strengthened and our trainee error rates decreased, leading to improved patient care.

Original languageEnglish (US)
Pages (from-to)1155-1159
Number of pages5
JournalAmerican Journal of Roentgenology
Volume205
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Brain Edema
Intracranial Pressure
Hydrocephalus
Curriculum
Infarction
Blood Vessels
Patient Care
Hemorrhage
Education
Infection

Keywords

  • Critical findings
  • Interpretation
  • Neuroradiology
  • Quality improvement
  • Radiology education

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Opportunities for targeted education : Critical neuroradiologic findings missed or misinterpreted by residents and fellows. / Huntley, Joseph H.; Carone, Marco; Yousem, David Mark; Babiarz, Lukasz S.

In: American Journal of Roentgenology, Vol. 205, No. 6, 01.12.2015, p. 1155-1159.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. We reviewed neuroradiology cases in which a resident or fellow missed a significant finding, to identify potential areas of deficiency that could be strengthened through targeted education. MATERIALS AND METHODS. Included in the study were all neuroradiology reports from 2011 through 2013 that were marked with an electronic flag to indicate a significant modification between the preliminary and final versions. The reports were examined to determine whether a critical finding (CF) or a non-CF was missed, with the use of a hospitalapproved list of 17 neuroradiology CFs. Results were analyzed for all trainees. RESULTS. A total of 978 modified reports were found among reports from 225,628 neuroradiology examinations. Of these modified reports, 891 (91.1{\%}) contained an addendum that identified the discrepancy: 658 (73.8{\%}) contained a CF,192 (21.7{\%}) contained a non-CF, and 41 (4.6{\%}) were changed from containing a CF to not containing a CF. A total of 725 missed CFs were found in the 658 modified reports. The CF miss rate for all trainees was 6.0{\%} (95{\%} CI, 5.6-6.4{\%}), whereas that for residents was 8.6{\%} and that for fellows was 4.8{\%}. Residents missed hydrocephalus, intracranial pressure or edema, new hemorrhage, and new infarction more frequently than did fellows. The five most frequently missed CFs were congenital variation, infection, misplaced hardware, a new or enlarging mass, and vascular abnormality. CONCLUSION. Our trainees' overall CF miss rate was 6.0{\%}. Five CFs had miss rates of approximately 10{\%} or more, and residents missed four of the CFs more frequently than did fellows. With the use of these data, our curriculum could potentially be strengthened and our trainee error rates decreased, leading to improved patient care.",
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N2 - OBJECTIVE. We reviewed neuroradiology cases in which a resident or fellow missed a significant finding, to identify potential areas of deficiency that could be strengthened through targeted education. MATERIALS AND METHODS. Included in the study were all neuroradiology reports from 2011 through 2013 that were marked with an electronic flag to indicate a significant modification between the preliminary and final versions. The reports were examined to determine whether a critical finding (CF) or a non-CF was missed, with the use of a hospitalapproved list of 17 neuroradiology CFs. Results were analyzed for all trainees. RESULTS. A total of 978 modified reports were found among reports from 225,628 neuroradiology examinations. Of these modified reports, 891 (91.1%) contained an addendum that identified the discrepancy: 658 (73.8%) contained a CF,192 (21.7%) contained a non-CF, and 41 (4.6%) were changed from containing a CF to not containing a CF. A total of 725 missed CFs were found in the 658 modified reports. The CF miss rate for all trainees was 6.0% (95% CI, 5.6-6.4%), whereas that for residents was 8.6% and that for fellows was 4.8%. Residents missed hydrocephalus, intracranial pressure or edema, new hemorrhage, and new infarction more frequently than did fellows. The five most frequently missed CFs were congenital variation, infection, misplaced hardware, a new or enlarging mass, and vascular abnormality. CONCLUSION. Our trainees' overall CF miss rate was 6.0%. Five CFs had miss rates of approximately 10% or more, and residents missed four of the CFs more frequently than did fellows. With the use of these data, our curriculum could potentially be strengthened and our trainee error rates decreased, leading to improved patient care.

AB - OBJECTIVE. We reviewed neuroradiology cases in which a resident or fellow missed a significant finding, to identify potential areas of deficiency that could be strengthened through targeted education. MATERIALS AND METHODS. Included in the study were all neuroradiology reports from 2011 through 2013 that were marked with an electronic flag to indicate a significant modification between the preliminary and final versions. The reports were examined to determine whether a critical finding (CF) or a non-CF was missed, with the use of a hospitalapproved list of 17 neuroradiology CFs. Results were analyzed for all trainees. RESULTS. A total of 978 modified reports were found among reports from 225,628 neuroradiology examinations. Of these modified reports, 891 (91.1%) contained an addendum that identified the discrepancy: 658 (73.8%) contained a CF,192 (21.7%) contained a non-CF, and 41 (4.6%) were changed from containing a CF to not containing a CF. A total of 725 missed CFs were found in the 658 modified reports. The CF miss rate for all trainees was 6.0% (95% CI, 5.6-6.4%), whereas that for residents was 8.6% and that for fellows was 4.8%. Residents missed hydrocephalus, intracranial pressure or edema, new hemorrhage, and new infarction more frequently than did fellows. The five most frequently missed CFs were congenital variation, infection, misplaced hardware, a new or enlarging mass, and vascular abnormality. CONCLUSION. Our trainees' overall CF miss rate was 6.0%. Five CFs had miss rates of approximately 10% or more, and residents missed four of the CFs more frequently than did fellows. With the use of these data, our curriculum could potentially be strengthened and our trainee error rates decreased, leading to improved patient care.

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KW - Quality improvement

KW - Radiology education

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