Experience matters: Early career radiology residents struggle with complex CT interpretations when fatigued
Fatigue is an everyday battle in healthcare and a significant contributor to medical errors. And for radiology residents, a new study found that the feeling can negatively affect diagnostic ability and efficiency, depending on experience.
That research, published Wednesday in Academic Radiology, included a small group of radiology residents in their second, third and fourth years. After a full day or night of reading complex CT exams, year-two trainees detected far fewer abnormalities and interpreted fewer cases than their more experienced counterparts.
Henry Zhan, MD, with Emory University’s radiology division and colleagues, say the experience-level variation is “new and interesting information” that may reveal how rads adapt throughout their training.
“Although we knew from our prior studies that residents typically experience greater levels of fatigue and their diagnostic performance suffers when fatigued more than attendings, we did not expect to find significant differences as a function of year of residency,” Zhan et al. wrote “It would appear that by the third year, residents are developing ways to cope with fatigue and are becoming more like attendings. They still make errors, but not to the same degree as second year residents,” they added.
Powered by a National Institute of Biomedical Imaging and Bioengineering grant, Zhan and colleagues had 10 residents complete two one-hour image interpretation sessions at least 21 days apart. Participants also answered a fatigue questionnaire before the sessions.
No resident was able to complete the entire caseload, and, on average, participants read 7.5 exams when they were fresh (before any reading activity) compared to 7.3 when fatigued. Fourth and third year trainees interpreted more cases when they were tired and spent less time on each, compared to second year rads who read far fewer and labored longer over each exam.
Fourth year residents detected the highest number of major findings in both conditions and had the smallest drop in performance when tired; year three residents followed closely behind. Second year participants, however, found “far fewer” true positives after a day of looking over images.
Some of the results are likely attributable to the increase in confidence and knowledge rads gather as they progress through residency, the experts wrote. But the research may have implications for how residents are scheduled and in setting expectations during training.
“Clearly having residents read for only a few hours at a time is impractical, but developing ways to stagger schedules, insert mandatory breaks as feasible and simply educating residents and faculty are potentially easily adopted,” the authors concluded.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.