Around-the-clock attending radiology coverage is essential to avoid mistakes in the care of trauma …
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The proposed ACGME change delaying in house call to the second year of Radiology residency is a step that has the potential to greatly affect both residency programs and radiology residents
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Delaying in house call for Radiology Residents – is there data to support it? Compiled by Thomas J. Henry M.D and Spencer B. Gay M.D. The proposed ACGME change delaying in house call to the second year of Radiology residency is a step that has the potential to greatly affect both residency programs and radiology residents. This issue of first-year radiology resident (PGY-2) preparedness for taking overnight call comes forward against a background of increasing pressure from other departments for around the clock in-house attending supervision1. These demands may be based more on anecdotes and preferences, rather than on any direct evidence of decreased quality of patient care. We performed a Medline search of relevant articles since 1990. Several retrospective reports have been published by radiology training programs documenting resident errors in interpretation measured against the subsequent attending overread, primarily in head CT2-5. To our knowledge, no data exists to suggest that these PGY-2 residents are insufficiently trained to take call. The only manuscript6 evaluating residents after 6 months training reported that the scores of were not significantly different on a computer based pre call exam to upper level residents. Current data supports that existing structure of residency provides for residents that make relatively few ( < 2%) important errors in diagnosis. Errors for head CT that did not significantly impact patient care were more commonly made (5-8%) were found. There is generally a small improvement in error rate as training increases, but no significant change has been shown for important errors between levels. The goal of zero errors may not be possible even with board- certified dedicated ED radiologists. Our own and other’s experience teaching and testing residents prior to independent night call with backup appears prudent and discrepancies have been minimal. The cost of making such a change in call structure is that first year residents will have no independent experience and that more senior residents will be doing call when they could be in positions providing more effective education. The benefit is likely very small, because there has been no data published to show that a problem exists. It is arbitrary to declare a resident with 12 months training more ready for call than a resident with 6 or 9 or 24 months, without implementing some system that objectively tests and demonstrates each resident’s preparedness. Whether a PGY-2 or and board eligible PGY-5 resident, this is still a less “experienced” radiologist than the greenest general radiologist attending. We should be cognizant that our clinical colleagues will always prefer to have a staff radiologist in-house 24 hours a day. The training of radiology residents - which in part has always relied upon taking independent overnight call - is our responsibility and we need to consider this change and the full result.
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