Trainee Knowledge of Imaging Appropriateness and Safety: Results of a Series of Surveys From a Large Academic Medical Center

Objective

In order to provide high quality care to their patients and utilize imaging most judiciously, physician trainees should possess a working knowledge of appropriate use, radiation dose, and safety. Prior work has suggested knowledge gaps in similar areas. We aimed to evaluate the knowledge of imaging appropriateness, radiation dose, and MRI and contrast safety of physician trainees across a variety of specialties.

Methods

Between May 2016 and January 2017, three online surveys were distributed to all interns, residents, and fellows in ACGME accredited training programs at a large academic institution over two academic years.

Results

Response rates to three surveys ranged from 17.2% (218 of 1266) for MRI and contrast material safety, 19.1% (242 of 1266) for imaging appropriateness, to19.9% (246 of 1238) for radiation dose. Overall 72% (509 of 706) of survey respondents reported regularly ordering diagnostic imaging examinations, but fewer than half (47.8%; 470 of 984) could correctly estimate radiation dose across four commonly performed imaging studies. Only one third (34%; 167 of 488) of trainees chose appropriate imaging in scenarios involving pregnant patients. Trainee post-graduate year was not significantly correlated with overall radiation safety scores, and no significant difference was found between radiation safety or appropriate imaging scores of those who participated in a medical school radiology elective vs. those who did not. A total of 84% (57 of 68) of radiology trainees and 43% (269 of 630) of non-radiology trainees considered their knowledge adequate but that correlated only weakly correlated to actual knowledge scores (p<0.001). Most trainees (73%, 518 of 706) agreed that more training in these areas would have beneficial effects on patient care.

Conclusions

Knowledge gaps pertaining to appropriateness and imaging safety exist among many trainees. In order to enhance the value of imaging at the population level, further work is needed to assess the most appropriate method and stage of training to address these knowledge gaps.

Introduction

A central role of physicians has long been that of diagnostician. The diagnostic process has been viewed as an iterative process of information gathering and interpretation, with the selection and ordering of diagnostic tests being a critical step in the diagnostic pathway.¹ Imaging often plays a critical role in this process. Advances in imaging technologies and accessibility have greatly increased the use of diagnostic imaging in recent decades but there may be important knowledge gaps among physician trainees when it comes to ordering these tests. Physician knowledge of the costs of imaging has been widely studied,² but the extent of their knowledge of other factors such as exposure to ionizing radiation, intravenous contrast, and possible interactions with implantable devices is poorly understood.

Multiple prior studies have assessed physicians’ knowledge of radiation risks at various stages of physician education and in multiple practice settings. Generally, physicians across many specialties and levels of training have performed poorly on surveys assessing their understanding of radiation dose, safety, and potential hazardous effects.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Similar results have been seen with respect to physicians’ knowledge of magnetic resonance imaging (MRI) and contrast material-related safety, as well as diagnostic imaging appropriateness.18, 19 In the academic setting, physician trainees (ie, interns, residents, and fellows) should possess a working knowledge of associated risks and appropriateness of these tests to provide high-quality and high-value care, and to address any concerns with their patients.4, 20 Importantly, they continue to order those studies after training, when they begin to practice independently.

The purpose of this study was to evaluate the knowledge of physician trainees across a variety of clinical specialties regarding several key topics related to ordering diagnostic imaging examinations. These include appropriateness, radiation dose, and both MRI and contrast safety considerations. We also sought to assess trainees’ perceptions of the adequacy of their education in these important areas.