ACR appropriateness criteria unpopular among medical students

Use of the American College of Radiology Appropriateness Criteria (ACR-AC) is low among radiology medical students, according to a recent study published by Academic Radiology.

Emily M. Webb, MD, of the department of radiology and biomedical imaging at the University of California, San Francisco, and colleagues surveyed third-year radiology medical students in October 2014 about placing orders and consulting appropriate use criteria.

Overall, the survey found that 68 percent of the students had ordered an imaging exam, and 64.8 percent consulted with a resource to help them determine what to order.

The authors pointed out, however, that ACR-AC awareness among these students was low. When asked specifically about the criteria, 11.3 percent of respondents said they had heard of it.

Immediately after taking that survey, the students were presented with a detailed lecture about ACR-AC and then interviewed again six months later. This second set of data showed that awareness of the criteria was up big, from 11.3 percent to 82.4 percent, but actual utilization showed no significant improvements.

“This underutilization is concerning for the immediate impact on their patients but also is significant for the lost opportunity for radiologists to influence imaging practices shown to be inefficient currently,” the authors wrote.

The authors pointed out that at least part of the reason utilization did not increase after the lecture was that the study was focused on students and not professional radiologists. These are individuals who are still relying on supervisors to make decisions.

“It is likely that to some extent, the medical student's subordinate role on the clinical team may have impaired introduction of the ACR-AC as a new tool, when most more complex imaging decisions were likely made by supervising physicians,” the authors wrote. “Even when imaging appropriateness resources were consulted, the students would likely defer to their residents or attendings preferred sources, an occurrence that was reported by some students. If any attempts at increasing familiarity with the ARC-AC are to have substantial effect on medical students' imaging habits, supervising residents and faculty would likely need to be targeted, as well.”

Based on their interviews, the authors recommend that the ARC find a way to put its criteria into an “easy to use, easy to access, searchable, online mobile application–based format.” The authors also cited previous authors who have suggested the criteria’s format could be more visual and “user friendly.”

(Editor's note: this story originally mentioned that the study suggested ARC-AC should be incorporated into a clinical decision support program. That has been removed, since ARC-AC is incorporated into ACR Select.)