Should Medical Schools Incorporate Formal Training in Informatics?

Are we preparing future generations of physicians with the skills to practice in the information age? Has the health care IT industry matured to the stage that we can standardize training physicians in how to search and synthesize massive databases of clinical information and tease out complex diagnoses based upon scant information? Will literacy in information technology become a differentiator between physicians’ abilities? For the proposition of changing existing curriculum in medical schools to incorporate formal informatics training is Michael Chen, a second year medical student at the University of Maryland School of Medicine. Taking the opposing position is Nabile Safdar, M.D., assistant professor of radiology at the University of Maryland School of Medicines

Vision and Quality in the Digital Imaging Environment: How Much Does the Visual Acuity of Radiologists Vary at an Intermediate Distance?

Objective:The Purpose of this study was to examine the intermediate-distance visual acuity of a cross section of radiologists and to identify variation in visual acuity during a typical workday. Subjects and Methods: Forty-eight radiologists completed a brief survey before undergoing visual acuity testing, with corrective lenses if routinely used, at three times of the day. Testing was performed with modified versions of a U. S. Federal Aviation Administration visual acuity test instrument. Results: The mean acuity of radiologists across all measurements was 20/15 (logarithm of the minimum angle of resolution [logMAR], -0.109 +/- 0.105 [SD]). Visual acuity ranged from 20/30 to 20/10 (logMAR, 0.176 to -0.301). Mean visual acuity in the morning session was approximately 20/16 (logMAR, -0.0856). This value was statistically significantly lower than the mean visual acuity in both the early afternoon (logMAR, -0.124, p = 0.003) and the late afternoon (logMAR, -0.118, p = 0.015), both of which were approximately 20/15. This change was within the expected test-retest variability of Snellen acuity measurements. Conclusion: Although a statistically significant difference was detected between the visual acuity of radiologists in the morning and acuity in other parts of the day, this difference was relatively modest and within previously published ranges of variability for similar visual acuity tests. It is unlikely that such variation in visual acuity among radiologists influences diagnostic performance. Not every radiologist had 20/20 vision, a few needed visual correction, and more than a few had not undergone a thorough eye examination for as many as 15 years before the study

Unbiased review of digital diagnostic images in practice: informatics prototype and pilot study

RATIONALE AND OBJECTIVES: Clinical and contextual information associated with images may influence how radiologists draw diagnostic inferences, highlighting the need to control multiple sources of bias in the methodological design of investigations involving radiological interpretation. In the past, manual control methods to mask review films presented in practice have been used to reduce potential interpretive bias associated with differences between viewing images for patient care versus reviewing images for purposes of research, education, and quality improvement. These manual precedents from the film era raise the question whether similar methods to reduce bias can be implemented in the modern digital environment. MATERIALS AND METHODS: We built prototype “CreateAPatient” information technology for masking review case presentations within our institution’s production Radiology Information and Picture Archiving and Reporting Systems (RIS and PACS). To test whether CreateAPatient could be used to mask review images presented in practice, six board-certified radiologists participated in a pilot study. During pilot testing, seven digital chest radiographs, known to contain lung nodules and associated with fictitious patient identifiers, were mixed into the routine workload of the participating radiologists while they covered general evening call shifts. We tested whether it was possible to mask the presentation of these review cases, both by probing the interpreting radiologists to report detection and by conducting a forced-choice experiment on a separate cohort of 20 radiologists and information technology professionals. RESULTS: None of the participating radiologists reported awareness of review activity, and forced-choice detection was less than predicted at chance, suggesting radiologists were effectively blinded. In addition, we identified no evidence of review reports unsafely propagating beyond their intended scope or otherwise interfering with patient care, despite integration of these records within production electronic workflow systems. CONCLUSION: Information technology can facilitate the design of unbiased methods involving professional review of digital diagnostic images