Study challenges rationale for ban on night call coverage by first-year residents

The decision may be made, but the war of words surrounding the Resident Review Committee for Radiology's resolution to change call eligibility requirements from six to 12 months of residency training wages on. A study presented at the RSNA meeting finding no statistically significant difference in diagnostic accuracy between the two groups of resident is the latest salvo in the battle.

The retrospective study reviewed 1464 emergency room exams by residents in the seventh and the 13th month of training. The overall significant error rate was 3.1%, with a significant error rate of 2.8% for residents who recently completed their twelfth month of training and 3.4% for those who recently completed their sixth month of training - not a statistically significant difference, according to study author Dr. Timothy Ziemlewicz, a resident at Wayne State University in Detroit.

The study was undertaken in response to the new call eligibility requirements.

"There was a lot of talk among residents at different meetings about how no studies compared those two periods to see if there was any difference as far as error rates," Ziemlewicz said. "Our study shows there is not."

Dr. Stephen Amis, chair of radiology at Thomas Edison University in New York and chair of the Radiology Review Committee of the Accreditation Council for Graduate Medical Education, did not respond to telephone inquiries about the Wayne State study, but he did discuss the RCC's decision to change the resident call eligibility requirements with Diagnostic Imaging in July. He stressed then that residents need more than six months of training to competently handle late night call.

"There are all sorts of accuracy studies being performed and published," he said. "There is no doubt that residents have a pretty good track record. However, there is no doubt that an additional six months of training makes them even better. If that were not the case, the residency could be six months long instead of four years."

As a resident, Ziemlewicz said he understands the impetus behind the new requirements

"Overall, on a national level, it sounds better when you say we don't let our residents take call until they've had a year of training," he said.

By accepting 10 new residents per year, Wayne State's program is large enough to adjust to the more stringent requirements, Ziemlewicz said. Smaller programs, however, may not be so lucky. Some smaller programs have had to increase the total number of calls that individual residents take. The increased workload may serve as a learning experience, but it detracts from other learning opportunities and the ability to do regular daytime clinical work.

"I've talked to residents from smaller programs, and they're really worried about how they're going to handle on-call coverage and still be able to get the experience they need," he said.

The study is also being used in Ziemlewicz's program to fine-tune resident education, he said. For example, body CT showed the greatest difference in error rates between six-month (5%) and 12-month residents (3%). While that is not a statistically significant error rate, it does point to an area where improvement is needed.

"We're trying to show [first-year residents] more of the things that were missed, such as retroperitoneal hemorrhages and other hemorrhages that people missed in trauma cases," he said. "They may not have seen some of the trauma on their rotations that you see more on call. They don't know everything that they're looking for yet when they start call."

Amis anticipated that problem when he spoke with Diagnostic Imaging in July

"The trend in graduate medical education is for closer supervision of residents, not less," he said. "I'll put my money where my mouth is: I've been chair at Einstein/Montefiore for 16 years. For all those years, my residents have had a year of training before being allowed to function alone at night."

For more information from the Diagnostic Imaging archives:

Residents rarely err in late night interpretations

ER-dedicated practitioners may address workload challenges

Analysis teases true value of outsourcing anytime reads

Diversity, technology attract radiology recuits