Image evaluation performance of diagnostic radiographers: benchmarking new graduates

Aim: Preliminary clinical evaluation (PCE) is a new clinical role of diagnostic radiographers in the United Kingdom (UK). Radiographers participating in PCE are now expected, not only to view radiographs and make reliable clinical decisions, but also to express the clinical findings in unambiguous written forms. The Society and College of Radiographers (SCoR) (2013) expects that newly qualified radiographers have the underpinning education and training to take part in PCE. However, the feasibility of PCE by radiographers, especially newly qualified radiographers, has not been empirically challenged. This research therefore set out to determine whether final year diagnostic radiography students at the point of graduation and qualification were capable of providing reliable PCE. Method: An X-ray image evaluation test was conducted to assess PCE performance of the final year undergraduate diagnostic radiography students. An image bank, consisting of 30 appendicular radiographs, was developed for the test. A total of 87 students from nine universities in England and Wales took the test. The students provided their clinical decisions (normal or abnormal) and comments (PCE). Accuracy, sensitivity and specificity were calculated based on their decisions. A PCE taxonomy was developed to classify comments and identify types and frequencies of PCE errors. The comments were also systematically evaluated with a scoring system, which was developed to assess three essential components of skeletal trauma reports: type, location and displacement/dislocation of fractures. Comments were further analysed by the results of the scoring. Results: The results demonstrated that mean sensitivity and specificity of the student group were 79.62 % (95% CI: 77 – 82%) and 67.13% (95% CI: 64 – 71%) respectively. Accuracy was 73.37% (95% CI: 72 – 75%). PCE error classification found that the students made more false positives than false negatives. A further analysis of the comments using the scoring system indicated that, although many commented on types and locations of abnormalities, very few described displacement/dislocations of fractures. Conclusion: Low specificity with higher rate of false positive decisions suggests that education providers should collaborate in partnership with clinical placement sites to devote greater focus on evaluation of normal radiographs. A certain proportion of newly qualified radiographers may benefit from post qualification learning to provide more reliable PCE. Preceptorship, which is a transitional phase for newly qualified radiographers to become independent practitioners, could incorporate PCE training as one of its key educational components. The error classification system and scoring model are ideally suited for regular audits at any stage of image evaluation learning and practicing.