Research Priorities in the Utilization and Interpretation of Diagnostic Imaging: Education, Assessment, and Competency

Abstract

The appropriate selection and accurate interpretation of diagnostic imaging is a crucial skill for emergency practitioners. To date, the majority of the published literature and research on competency assessment comes from the subspecialty of point-of-care ultrasound. A group of radiologists, physicists, and emergency physicians convened at the 2015 Academic Emergency Medicine consensus conference to discuss and prioritize a research agenda related to education, assessment, and competency in ordering and interpreting diagnostic imaging. A set of questions for the continued development of an educational curriculum on diagnostic imaging for trainees and competency assessment using specific assessment methods based on current best practices was delineated. The research priorities were developed through an iterative consensus-driven process using a modified nominal group technique that culminated in an in-person breakout session. The four recommendations are: 1) develop a diagnostic imaging curriculum for emergency medicine (EM) residency training; 2) develop, study, and validate tools to assess competency in diagnostic imaging interpretation; 3) evaluate the role of simulation in education, assessment, and competency measures for diagnostic imaging; 4) study is needed regarding the American College of Radiology Appropriateness Criteria, an evidence-based peer-reviewed resource in determining the use of diagnostic imaging, to maximize its value in EM. In this article, the authors review the supporting reliability and validity evidence and

Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review

“…Reframing how imaging decisions are made in the ED and adopting a more patient‐oriented approach to these shared decisions may substantially influence utilization and the use of decision support tools. Introducing a larger reframing of the physician–patient relationship in medical education is likely to be an important facilitating factor of this shift in LBP imaging decisions and beyond …”

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference

“…Each group, a priori, determined a process for achieving consensus within the group. The output from each of these groups is summarized in other articles in this issue …”

“…All of the groups used modified versions of two validated and commonly used consensus methods: the nominal group technique and the Delphi technique . A description of the specific methodology for each group may be found in the individual group article . An iterative process including discussion and reprioritization occurred within the groups prior to the conference day.…”

Building Emergency Medicine Trainee Competency in Pediatric Musculoskeletal Radiograph Interpretation: A Multicenter Prospective Cohort Study

“…Thus, it is imperative for training programs to ensure that emergency medicine trainees develop competence in the skill of pediatric musculoskeletal (MSK) radiograph interpretation before they make high-stakes decisions with patients in independent practice. 2,3 Unfortunately, the interpretation of pediatric MSK radiographs has been shown to be relatively deficient among graduating pediatric and emergency medicine residents who will be working in EDs. [4][5][6][7][8] These training results echo what has been noted in clinical practice, where misinterpretation of pediatric MSK radiographs in general and pediatric EDs has been estimated to be up to 19%, 1,[9][10][11] and pediatric extremity radiographs have been found to be one of the most common causes of discrepant radiograph reports.…”

“…An appropriate initial diagnosis decides management, minimizing morbidity and long‐term dysfunction. Thus, it is imperative for training programs to ensure that emergency medicine trainees develop competence in the skill of pediatric musculoskeletal (MSK) radiograph interpretation before they make high‐stakes decisions with patients in independent practice …”